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Home My WebLink About7842-z FOEM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7842 Z Permission is hereby granted to: ~w!z~..Eor~..~'.e~.ce...C.a...&/C...~s.....~io~ ............ .~.~i-~ok. ........................................ ~o .~.r.~..e..~..~.~.¢....~. ~.~.~....~.r..q~.~....a....s..~..e...~..~...f..e.~.~..~.~.~.~....-...~9..~4.~..~...~.~.e..k.~..~ .. at- premises located at ..~t..~- ............ Q,~,~t~e~..~l~lJ~h~ .............................................................. ........................... : ........................... 3?..o......~.e..e..~..~.o..~.¢ ......... .~,.~ ~.%,~.t..~ .e..x......~.....~.: .................. pursuant to application dated .......................~.~.;~], .... ~ ........... , 19..~.~..., and approved by the Building, Inspector. Fee $...~.~..?...(~... .......... ...... · /~-Q~i'~-~.-i:~spect~or.!. ~ ..................... FOILM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No....?.~.~./...~ ......... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Th~s apphcation must be completely filled in by typewriter 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 location of lot and of buildings on premises, relationship to adloming premises or pubhc streets o areas, and gwmg a detailed description of layout ofproperty must be drawn on the diagram which is part of th~s applicahon c. Zhe work covered by this apphcat~on may not be commenced before issuance of Building Permit. d. Upon approval of th~s apphcahon, the Building Inspector wdl ~ssue a Building Permit to the apphcant Such permi shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or ~n part for any purpose whatever until a Certificate of Occupanc' shall have been granted by the Budding Inspector. APPLICATION IS HEREBY MADE to the BuJdmg Department for the ~ssuance of a Building Permit pursuant to th. Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o Regulahons, for the construction of buildings, additions or aJterat~ons, or for removal or demolition, as herein described The applicant agrees to comply w~th all apphcable laws, ordinances, building code, housing code, and regulations, and t, admit authorized respecters on premises and in. buildings for necessary inspechons. (S~gnature of applicant, or name, Jfa corporation) ..... ............. (Address of apphcant) State whether apphcant ns owner, lessee, agent, architect, engineer, general contractor, electrician, plumber ar buiJde~ Name of owner of premises .......... .~ ~ I ..~-.~-~ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Budder's bcense No .................................................... Plumber's License No ................................................ Electnaan'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 ....... ~;3.~..p.......~.~.~.,~z~. ........ ~.~.. ........... ~~...C~ ................. Municipality State ex~sting use and occupancy of premises and intended use and occupancy of proposed construction: a. Ex,s,ting use and occupancy ................. ~....~......~...~ ........................................... b. Intended use ond occupancy .......................................................... ~,,~.~. ~,.,.~. ~.). ............................ 3 Nature of work (check which apphcable): New Building .................. Addlhon ................ ~ 'Alter°t,i°n ........ Repair .................. Removal .................. Demohhan ................ Other Work ........ ~~... /~ (Descnptj~) 4. Estimated Cost ................ ~...~..~.~.....'. ....................... Fee ................ .~.~....'?' .............................................. (to be paid on fihng thru apphcahon) 5 If dwelling, number of dwelling umts ........................... Number of dwelhng umts on each floor ................... If garage, number of cars ........................................................................................................................... 6. If business, commeroal or m~xed occupancy, specify nature and extent of each type of use .................. 7 Dimensions of existing structures, if any: Front .......................... Rear ................................ Depth .............. Height ........................ Number of Stories ............................................................................................ Dimensions of same structure with alterahons or additions. Front ................................. Rear ........ Depth .............................. Hmght ......................... Number of Storms ............................ 8. Dimensions of enhre new construchon: Front ................................ Rear ............................ Depth ........ Height .................... Number of Stories ................................................................... 9 S,ze of lot' Front .............. ~.~..c~. ............................... Rear ........... .'~.~..¢~ ..................... Depth .. ~?, .,,~.oc~. .......... 410 Date of Purchase .................................................... Name of Former Owner ........................................... fl 1 Zone or use district in whmh premises are situated ..................................................................................... ~12 Does proposed construct,on v~olate any zoning law, ordinance or regutahon ................................................... 13. Wdl lot be regraded ............................ WHI excess fill be removed from premises' ( ) Yes_ ( ) No 14. Name of Owner of premises ...~.~...~.~.,~Address ..... --- ~ ~..d~hone No. ~...~...~..~..~..~. Name of Architect .................................................... Address ................................ Phone No ...................... Name of Contractor ..................................................... Address ................................ Phone No ...................... PLOT DIAGRAM Locate clearly and d~stmctly all buddings, whether ex~stmg or proposed, and red,cate all set-back &mansions fron property hnes Gwe street and block number or description according to deed, and show street names and in&cat whether inlerior or corner lot STATE OF NEW YOR~,, -- I'S S r~ . . , ...~~...~.~...C.~.~r~ .................. be~ duly sworn, deposes and says that he is the apphca?, (Name of indw~dual s~gnlng contracf) above named He ,s the .......... ~~ ............................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the smd work and to make and th~s applicahon, that all statements contained ~n thru application are true to the best of hm knowledge and behef, that the work will be performed ~n the manner set fo~h m the application filed therewith. ~ Sworn to before me this _ . . ~ ~ ...... o, ...... ........... , / · ' M, ,-,.75, ~ ~~ ~(S~ture ofapphcant) L~,~ ~ . ~ ~.t ( '~ NGTAPY PdS~lC. ~ta~e of Hew Yo~k ~" ~ '~ No, 52-4322'D26 - 5~ ;~,:' Cou~fy ~ / Comm:sslon ~xptros Marcf? 30,