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Home My WebLink About7858-z FOH~ NO. 2 TOWI4 OF SOUTHOLD BUILDING DEFARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING FERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 7858 Z Permission is hereby granted to: ..~.q.2..t;/~,~ ..... ~l;~,l 0.~ .................................... ....... Z~D~..~o~d .............. 14;.t £., .................. to ~..~ %~d..~e.~..~c c.~ s.~ or.~...btziZ &ir~ .................................................................................. a~ premises located at ..]~5...~..Ti+....~a.p~...z~Sv~c~ ............................................................................. ............................................. ~ni~..,~oa~t, ............ ~ ,~-tt-.~.tuek ....... ~4.,.~., ........................................... pursuant to application dated .......................... A~_/.].....2.c). ....... , ~9~.~..., and approved by the Building Inspector. Fee $.t .O..'.i~ ............ Examined Approved IVOn,_M NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. AP~LICAT,ON ~O~ BU,LD,N~ PERM,T Date ............ ~...~.~ ..... , ~.Z~..-.. INSTRUCTIONS o This application must be completely filled in by typewrtter or in mk and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing Iocahon of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout ofproperty must be drawn on the d~agram which is part of this application. c. The work covered by this application may not be commenced before ~ssuance of Building Permit. d Upon approval of this application, the Building Inspector w~ll ~ssue a Building Permit to the apphcant. 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 or Regulations, 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 to admit authorized tnspectors on premises and in buildings for necessary inspections. ('Signature of applicant, or name, if a corporation) ... ......./.T q ' ...:.~..:?...~....l.-,.... .~.... ..................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If apphcant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ...... (~.C~...~ ....................... Plumber's L~cense No ................................................. Electrician's License No ............................................. Other Trade's License No .............................................. /"~/ /,- m ,~ L' 1. Location of land on which proposed work will be done Map No .... .~..../~.....~...~. ........ Lot No..~,.~..~.. Street and Number ~.~,£~/?~ .~...~...0...O,....O/. ...... ..~-..~-L~..J~../:/(2..../..~....C..~..f~. .... ~.~ .~...~.~. ...... ........................... Muni¢ipoiii~) ....... 2 State ex~sting use and occupancy of prer/~es and in'ended use and~,occupancy of proposed construction' o occ.,:,c,.c.,. .........t,.,, ........................................................ .......... b Intended use ana occupancy ......................................~:'~' ............... ~ ..................... ~ ................................ 3. Nature of work (check which applicable). New Budding ........... Addition ............... Alterahon ...... Repo,r .................. Removal .............. Demoht,or. ........ .... ~.. Other Work . .~..~..~..J:'..~../~'./~...~..C~.~,~-~..,~-.~ . .,//) ~~ ~l(Description) 4 Estimated Cost .................. ~..~.0....~ .......... :e~.: ..... .~..,~.~/.. ~: ...... ...... (to be prod on fihng th~s apphcat~on~' 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, specify nature and extent of each type of use ......................... 7 Dimensions of ex~st~ng structures, if any' Front ...................... Rear ................................Depth ................ Height ........................ Number of Stones ........................................................................................................... D~mens~ons 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 ............................................................................................... 9 Size of lot' Front .................................................... Rear ................................... Depth ............................ 10. Date of Purchase ........................................................Name of Former Owner ........................................................ 11. Zone or use distnct in which premises are situated ................................................................................ 12 Does proposed construction violate any zoning law, ordinance or regulation ......................................................... 13 Wdl Iot be regraded ........................... Will excess fill be removed from premises: ( ) Yes ( ) No 14 Name of Owner of premises ................................................... Address ................................ Phone No. ...................... Name of Architect ................................................... Address ................................ Phone No ...................... Name of Contractor ..................... . ................... Address ................................ Phone No ...................... PLOT DIAGRAM Locate clearly and distinctly all buddings, whether ex~stmg or proposed, and red,cate all set-back dimensions frorr property hnes G~ve street and block number or descnphon according to deed, and show street names and indicate whether interior or corner lot ................... ~..'~....~.........~...~.~....~..~ ............ being duly sworn, deposes and says that he ~s the apphcon (Ix~l(e ~ md~wdual signing contracf) above name(5 ' is the ~555~ontractor, o~, corporate officer, ere ) of said owner or owners, and ~s duly authorized to ~r6rfarm or have performed the said work and to make and ill, th~s application; that all statements contained m th~s apphcohon are true to the best of h~s knowledge and behef; ant ti,aT the work wdl be performed m the manner set forth in the apphcat~on filed therewith. Sworn to before me th,Sol .z~...~~.~..- 197 .~'"~\ , ~ ~ ........... ~day ........ , , /"") ~ - Notary Pubhc, . ........ ~7~-y~ ...... County ..... ~ ~~ (Signature of applicant)