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Home My WebLink About7849-zTOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFIGE SOUTH'OLD, N. Y. BUILDING PERMIT CI-HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7849 Z Permission is hereby granted to: .~i£11iam.._~ ~..l:,ma ot~ ................................ ...J~cap..~o!a..~rl.~ ...................................... .................. ¥~a.t.t...~eA~ ....................................... to .... .~.r.q.~.~...aiq~..~.l~a:Lu..~e.a~:Iaqg..~...ac.c. as.anr, y...hlill.~lllr, g ...................................... at premises located at ..D..e...e.12....H..o...~..e.....D..~.~.Y..e. ...................................................................................... ¥~ttituck N .Y. pursuant to application dated .........................A~/~.~.i ....... g~ .......19..~.~.., and approved by the Building Inspector. Fee $..1 .~. a .~. .......... FORM ~0, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E×om,ned '"~""" ...... ~"~ ...... ' ~"':'"" ...... .q..~.....'.....X. ........... App,cat,on No .................... : ............ Approved ........... ~. ......... ?. ......... ] ...... , 19 .....i.. Permit No. ~.. ~- '/ / ' " Disapproved a/c ............................................................................................ ................................... ........................ (Building Inspector) / APPLICATION FOR BUILDING PERMIT .......... ................. INSTRUCTIONS a This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildin£ Inspector, with 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 adjoining premises or public streets el areas, and gwlng a detailed descnption of layout of property must be drawn on the diagram which ~s part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o~ Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and t, admit authorized inspectors on premises and ir~ buildings for necessary inspections. (Signature of applicant, or name, if a corpor, qtipn). ..... ....... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ................................................... [;L)~ ........ 'A". ........ ,. -~.~'/~~;":~';~ ......................................................... Nome of owner of premises ............................................................................................................................................ If apphcant ~s a corporate, 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 ............................................... ................ .......... .oco,,o~ o, ,o.~ o. w~,~.~ ~ o o . ~,,~.~ Street and Number ............................................................................................................................................. Municipali~ Sfale existing use and occupancy of~mise~d ~nfended use and occupancy of proposed construction' a Exisiting use and occupancy .............. ; .................. ~ --~-~ ........... : ....... ] .......... : ..................................... b Intended use and occupancy ............................... .~~ ................ /...:....~ .......~....~.~ ........... 3 Nature of work (check which applicable) New Building ............... Addmon ..... ~.~A~Jt.ergtion Repair .................. Removal ............. Demolit,on .......... 0Ot~er Work .... 7 /~ - ' (Descr,ption) 4. Estimated Cost ........................................................... Fee .................................................................................... (~.,"~--~L (to be pa~d on filing thru apphcahon) 5 If dwelling, number of dwelhng units ........................ Number of dwelhng umts on each floor .......................... If garage, number of cars ........................................................................................................................... 6. If business, commercial or m~xed occupancy, speofy nature and extent of each type of use ........................... 7 D~mens~ons of ex~stmg structures, ,f any' Front ........................ Rear ............................... Depth .................. Hmght ........................ Number of Stones ........................................................................................................ Dimensions of same structure with alterahons or addmons Front .................................... Rear ................... Depih ................................ Height ....................... Number of Stones ............................... 8. D~mensions of enhre new construction: Front ................. · ............. Rear ........................... Depth ...................... He~§ht ................... Number of Stories ..................................................................................................... 9 S~ze of lot Front ...................................................... Rear ......................................... Depth .............................. 10. Date of Purchase ............................................... J.~6~ne ~)~?~rn~LcF Owner ....................................................... 11. Zone or use district in which premises are situated ............................................... 12 Does proposed construct,on ~c/lqt~ any zoning law, ordinance or regulahon ........................................................ 13 Will lot be regraded ..........~(.~.'~.~ ...... ~Jt ~_5~,e~,s.~e removed fro~.~!~ (.4~)~.y~s ( ) No 14 Name of Owner of premises ............................................... Address ................................ Phono No ....................... Name of Architect ....... ~'~,~CZ ..................... Address ................................ Phone No Name of Contractor ................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all bu,ldmgs, whether ex~sting or proposed, and red,cate all set-bock dimensions from property lines Gtve street and block number or descnpt,on accord,rig to deed. and show street names and indicate whether ,nter,or or corner lot CTATE OF N~.~'~''"~ ~ ................ ..?./(/'.......~ ......................................................... be,rig duly sworn, deposes and soys that he ,s the appliconl (Na~Y of ~ndiv~dual si~ing contract) above named He ~s the ..................................................................................................................................................................... (Contractor, agent, corporate officer, etc ) of s~d owner or owners, and is duly authorized to perform or have per~ormed the so~d work and to make and file this application; ~hot oll statements contained ~n this opphcahon are true to the best o~ his knowledge and belie~; and thor the work.wilt be performed~the manDer~ fo~h i~cot~on filed therewith Sworn to b~e this ........................ day of ~ ............ , 19 .... Not~ ~vblic, .:~....~...~: ........... :.~ ....... ~o~ ................................. : ......................... : .................................. :>:~,~ ~~ (S,gnoture of apphcont)