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Home My WebLink About7889-z FO~M ~TO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7889 Z Permission is hereby granted to: ~.~az~..~l~.....~'~ .............. ~.e...o...~..a...~....a.~. ............... l~att~Lt~ek ...................................... at premises located at ...LQ~...~..O......~.;~X~i~I~.,...I~4~.q~. ...................................................................... ..................................................... .g~e..Z~, e ............ ~4~ti.~ ............................................ pursuant to opplicotion doted .......................~ ......... ~. ............. , 19..~.~.., ond opproved by the Building Inspector. Fee $...~.~.~.(~ .......... Buildi~ TOWN OF SOUTHOLD BUILDING DEPARTMENT~ TOWN CLERK'S OFFICE SOUTHOLD, N Y . . 2 D~sapproved o/c ............................................................... APPLICATION FOR BUILDING PERMIT / Dote ................................. ..... , INSTRUCTIONS a Th~s apphcat~on must be completely filled m by typewriter or m ~nk and submitted In triphcate to the Budding Inspector, w 3 sets of plans, accurate plot plan to scale Fee accordmg to schedule. b. Pict plan showing location of lot and of buddings on premises, relationship to adjo~mng premises ol pubhc streets or areas, r g~wng a detaded description of layout of property must be drawn on d~agram whmh ~s part of th~s apphcatton c. The work covered by th~s apphcat~on may not be commenced before issuance of Building Permit. d. Upon approval of th~s apphcatlon, the Budding Inspector will issue a Building Permit to the apphcant Such permit,shall be kept the premises available for ~nspect~on throughout the work. e. No building shall be occupied or used m whole or in part for anv purpose whatever until a Certificate of Occupancy shall have b: granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Z, Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances or Regulatmns, for the constructm[ buddings, additions or alterations, or for removal or demoht~on, as harem described The applicant agrees to comply with all apphcable la, ordinances, budding code, housing code, and regulations, and to admit authorized inspectors on premises and ~n buildings for necessary inspectio~ ISlgnature of apphcant, or name, if a corporation-) (Address of applicant) ' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build ............ ....... ................................................................................................................... Name of owner of premises ..~..!..C..:......~.~ ...... ~;:~,~.jO3.c,-~l~ ............................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and t~tle of c~rate officer) · . Builder s Lmense No ................................... Plumber's License No ..................... ! ........................... Electricmn's License No ..................................................... Other Trade's L~cense No ................................................... } ~/'~// ~/z . _ 1. Location of land on which prop~)sed~j t~, tw°rk will be done. Map No ...... .~.-.~..- .~.~./...~..~.... Lot,,~ .i , ~N°' ./....~.. ............... Number ................. . .~..~..[..[ .G...~ .~.......~..~..: ................................................................. [.~. M~unt~ ......... Street and 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....... ..~..?....~...~....~:....: ...................................................................................................... b. Intended use and occupancy ................................................................................................................................ Natbre of work (check which applicable): New Building ....................... Addition ..................... Alteration.,*. ........ .':.. Repair ......................... Removal ......................... Demolition ........................ Other Work ...~i~.~..c.,~t.,~i 4. Estimated Cost ......... ~.~.~. ..................... Fee ..Z,.,~.,...~. ........................................................................ (to be pa~d on fdmg this apphcatton) 5. If dwelling, number of dwelling units .................Number of dwelling units 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, if any: Front .....................Rear ........................... Depth ................................... Height ........................................................... Number of Stories ............................................................................. Dimensions of same structure with alterations or additions: Front .......................... Rear ........................................ Depth ............................................. Height ......................................... Number of Stories ....................................... 8. Dimensions of entire new construction: Front ......................... Rear ............................ Depth ....~.C)..~ ................. Height ................................................. Number of Stor,es ....................................................................................... 9. Size of lot: Front ...................................... Rear .......................................... Depth ................................................ 10. Date of Purchase ..................................... Name of Former Owner ........................................................................... 11. Zone or use district in which premises are situated ................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... 0J~ ............................................... 13. Will Iotbe regraded .... (.IQ ....................... WJ~l excessfill be remqv.e~l from premises: [ ] Yes [~ No 14. Name of Owner of premises .. -~¢:r.~..,.~C4~i:laC,.~ ...... .V.t[~:;:~.~¢...~., ................... ~o,~.~...'-...¢~,.~.~: ........ '~ (Address) '~' (P~one r~o.) Name of Architect .................................................................................................................................................... N a me of Co ntractor ...F~4~. ~']~¢. ~2J~...~,...~., .................. Addr ~tr~ ~ .~f, (Phone No.) ................. ..... t ress) (Phone r~oj PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ex~sting or proposed, and indicate all set-back dimensions fro property lines. Give street and block number or description according to deed, and show street names and indicate whet er interior or corner lot. STATE OF NEW YORK, / _ ,~ x/ ) SS COUNTY OF ............. ) ....................................................................... being duly sworn, deposes and says that he is the apphcant above name {Name oJ l~dzvtd~al st~tl~g co~tract) ~ He ~s the ............. (Contractor, agent, corporate officer, etc } of sa~d owner or owners, and ~s duly authorized to ~rform or have performed the smd work and to make and file th~s apphcat~on; that statements contained m th~s apphcat~on are true to the best.~ ~s~k6~ge and behef, and that the work wdl be performed m the mani set forth ~n the apphcat~on filed therewith ~ - ~, ?ale o[ New Yo~ .............. vo ...,-,~,..~ ......... ,~ ...... ,~ ~~ ~ ......... ........ ............... ~ ~ ~Signature of appltcant)