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Home My WebLink About7865-z FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT 'TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING FERMIT (THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7865 Z Permission is hereby granted to: ...l~.an~-~!~...~...~:~r3.~...~r. oza ................ .................. .Q%k%~llQg.l~e .................................... at premises located ot%f~.~.....R~.ql_z~S~..$~.~e ....................................................................................... ............................................ .c...u..t,..c..b..o..t'...u..e. ....... .~:..tr., .................................. , ........................................... pursuant to application dated ...........................A..?.~..i..1. ..... .~..0. ....... , 19..7...~.., and approved by the Building Inspector. Building Inspector FO~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. .... ..........._ .... ........ Approved ....... .b/. ..... :.~. ....... :.~. ............ , 19.~.~.. Permit No. '~(~::~'Z Dmapproved a/c ........................................................................... APPLICATION FOR BUll. DING PI~RMIT ............................................... 19 ..... ;'. .... INSTRUCTIONS a. This application must be completely fdled m by typewriter or m ink 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 location of lot and of buildings on premises, relatmnsh~p to adjoining premises or public streets oF areas, and g~wng a detailed description of layout ofproperty must be drawn on the d~agrom which ~s part of this apphcation. c The work covered by th~s apphcation may not be commenced before issuance of Building Permit. d. Upon approval of th~s apphcation, the Budding Inspector will issue a Budding 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 ~n 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 thc 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 alterations, or for removal or demolition, as herein described: The apphcant agrees to comply with oil applicable laws, ordinances, building code, housing code, and regulations, and t; admit authorized inspectors on premises and ir~ buildings for necessary inspegtions.. (S~gnature of applicant, or name, if a corporation) ................. ............................. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises , ~ ~'-'~ ~- -~ ~- ~ ~L. ,. ~ .... ,~ ~ If applicant ~s a co~orate, s~gnature of duly authorized officer. (Name and t~tle of corporate officer) Builder's bcense No ....... Plumber's License No ................................................. Electrician's License No ............................................. Other Trode's License No ............................................... Location of land on wh~ch?ropo~ed work wdl be done. Map No ......... ~ ................ Lot No Number/~ .... ............ ,..,,:.,.,..~.~,d. ...... (~ .... . ......... d.k,,.,~Z'~,.x;..,~....~....;...),.¥.. .......................... Street and / Municipality State existing use and accupancy af premises and in~ended use and occupancy of propased constructian' b Intended use and occupancy ~/""'"~-~'"~l ........................................ 3. Nature of work (check which applicable). New Budding ............ Addition ................. Alteration Repair ................ Removal ................ Demohhor~ ........... Other Work ........ ~..-r u.4z..~.~.~ .............. .~ ~ (Description) 4 Estimated Cost .............. ~....: ...................................... Fee ..... (..Z ..................................................................... (to be pa~d on filing th~s apphcat~on) 5. If dwelling, number of dwelhng units ................ Number of dwelhng units 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~stmg structures, if any' Front ......................... Rear ................................Depth ................. Height ........................ Number of Stones ............................................................................................................. D~mens~ons of same structure w~th alterahons or addmons Front ................................. Rear ...................... Deplh ............................. Height ...........................Number of Stones ............................. 8 D~mens~ons of enhre new construction. Front ............................... Rear ............................ Depth .................... Height .................. Number of Stories ........................................................................................................ 9 S~ze of lot Front ........................................ Rear .................................... Depth ............................ 10. Date of Purchase ....................................... Nome of Former Owner ....................................................... 11 Zone or use district m which premises are situated ................................................................................... 12 Does proposed construction wolate any zoning law, ord,nance or regulation' . .................................................... 13 W~II lot be regraded ............................ Will excess fill be removed from prermses: ( ) 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 d~stlnctly all buddings, whether ex~st~ng or proposed, and indicate all set-back dimensions fron property hnes Gwe street and block number or descr~phon according to deed, and show street names and ind~cat: whether inlenor or corner lot STATE OF NEW YORK, [SS COUNTY OF ..................... ......... ..'~.~../. ......... '.~../. ........ ~...~...:~.5..(...z....~. ........................ being duly sworn, deposes and says that he ~s the apphcan (Name of Indw~dual signing contract) above named He ~s the ................ !~.~..~ ?.?..~....~. ......................................................................................................................... (Contractor, agent, corporate officer, etc ) of sa~d owner or owners, and ~s duly authorized to perform or have performed the said work and to make and f~l this apphcation; that all statements contained in this apphcat~on are true to the best of his knowledge and behef, an, tha~ the work w~II be performed m the manner set forth m the apphcation filed therewith Sworn to before me this ~ ~ ' ~- day of '~ rJ~:.-d.~-.~.~- ., 19~.,- - ~:" // '~-'~'~"~-" County Nota~ Public, . ............... ~.~ .............................. ~OT~ Pu~uc, St~, of~k No. 52-4522026 - Suff~ Courtly Commission Expires March 30, 19,..~ ~ignature of ap~fi~:ant)