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Home My WebLink About7841-z FOKM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne 7841 Z Permission is hereby gronted to: ~...~...~.o.~...~.~...c...o......f:.&c....9~..o..........~. o~a .... ......... ~.,e~t£J:~ck....!;.~ ................................. ....... ~,L~a~..~.~.r.~..a.;L...s..!..a.~...~.i..~....q..f...p.~.~&.s. ..................................................................... at premises located at ....... ~l~qtil~e..~l.~i ....................................................................................... ............................................................ !:~.~ ~.~&.u..e.~.,...: ,....~.:. ................................................................ pursuant to application dated ........................... ..A..~.~.~......?..~. ....... , 19.??..., and approved by the Building Inspector. Fee $..~.~.~.0.~. .......... FOR]~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Th~s apphcabon must be completely filled ~n by typewnter or' in ink and submitted in triplicate to the Buildin, Inspector, w~th 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing iocabon of Iot and of buildings on premises, relationship to adloming premises or public streets o areas, and g~ving a detailed descnpbon of layout ofproperty must be drawn on the d~agram which ,s part of th~s application c. The work covered by th,s applicabon may not be commenced before ~ssuance of Building Permit. d. Upon approval of this applicabon, the Building Inspector w,ll ~ssue a Building Permit to the applicant Such perm~ shall be kept on the premises avmlable for inspection throughout the work. e. No building shall be occupied or used m whole or in part for any purpose whatever until a Certificate of Occupant shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the ~ssuance of a Building Permit pursuant to th Bu,ldmg Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances c Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe; The apphcant agrees to comply with all apphcable laws, ordinances, building code, housing code, and regulations, and t admit authorized inspectors on premises and in. buildings for necessary inspections. (Signature of applicant, or name, if a corporation) State whether opphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or buHdm Name of owner of premises .......... k~..,~....,, ......... .(.~..~..~..¢...~.~...~...~."....../.'~.~. ..... .~..:..~.....~....~....~.....~. .................................................. If applicant is a co~orate, s~gnature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... Location of land on which proposed work will be done Map No ......................................... Lot No ....................... Street and Number ............. ..~...,.~...R...~.~,'.~ ..... ..Z.....~.J: ................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction' a. Exisiting use and occupancy ........ ct.. · .~:.~........~ .'.(~-. ~.~¥..t. l..k./ ........ ../4./ ....................................................... b. Intended use and occupancy // ,/ 3. Nature of work (check which applicable). New Buddmg .................. Addition ................. Alteration .... (Description) 4 Estimated' Cost ...................... ~, -- .............................. Fee .................. ./.,,,~ .................................................. (to be paid on filing this apphcat~on) 5. If dwelling, number of dwelling units .......................... Number of d~elhng umts on each floor ............... If garage, number of cars ......................................................................................................................... 6 If business, commercial or mixed occupancy, specify nature and extent of each type of use .................. 7 Dimensions of existing structures, Jf any: Front ......................... Rear ................................Depth ............. Height ........................ Number of Stories Dimensions of same structure with alterations or additions: Front .................................... Rear ........... Depth ................................Height ......................... Number of Stories ............................ 8. D~mensions of entire new construction. Front .................................. Rear ............................ Depth ............. Height .................... Number of Stories ................................................................ 10 Date of Purchase ................................................... Name of Former Owner ...... .~..~.?...~..z...~..~..?.: ........ 11. Zone or use d~stnct m which premises are s~tuated ................................................................................ 12 Does proposed construction wolate any zoning law, ordmance or regulation ..................................................... 13. Wdl lot be regraded .......................... Wdl excess fill be removed from premises. ( ) Yes ( ) No Name of Architect ............................................. Address ................................Phone No ...................... Name of Contractor .......................................................... Address ................................Phone No ...................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ex~sting or proposed, and indicate all set-back dimensions frorr property lines. Give street and block number or description according to deed, and show street names ond indicat.- whether interior or corner lot STATE OF NEW~YOI31~, -- [SS ........ ~' ~' A//" /'~J~ COUNTY OF :~~.~ ...... ~ '-~ .~~ . · -- ...... f..~.~z....~....~...~ ...... z..~.4~ ................................ De~ng aUly sworn, aeposes QnQ says thQt he ~s the apphcar~ (Nome of mdwidual s~gnmg contract) above named He .s the (Contractor, agent, corporate officer, etc ) of said owner or owners, and ~s duly authorized to perform or have performed the sa~d work and to make and ill( this application, that all statements contamed m this apphcation are true to the best of his knowledge and behef, tha~ the work will be performed in the manner set forth m the application filed therewith Swam to before me this , ~ ~ ~ ..... ~.~. doyo~ ....... ~ ............ , ]9~ ~ ~ r ~~. ~ ................ co ty ...... ~ ~ ?(Si~noture of ~pphc~nt) ~o. $2.4~22026 - Suffolk Goun~ ~ ~o~mI~s;~ ~xplr*s Marah 30. 19.,~