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Home My WebLink About7899-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERJ~,IT (THIS PERMIT MUST BE KEPT ON THE P]~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 7899 Z Permission is hereby granted to: ,~:.~..ff.o.,~..Ze.,~.e...e....c...o....~./..c...~.o.k~..~ez l~at~uek to .e..~.e...c..C....~..e..n..e..~.n..g.. £~.o...n..¢..,.. ~..t.~..e... ~.. ~ .e.~.~. ............................................................................. at premises located at .... .~..~.~...,~..~..~...~.~...~'~,3~'~ .......................................................................... ......................................................... .~.u.thold .................................................................................. pursuant to application dated ........................... J~.....~. ............... 19.?..~..., and approved by the Building Inspector. ~e~ ,.~.~.'.~ ........... FOn, M NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. INSTRUCTIONS Application No ...... 2...~..~..~.. ........ a. This apphcation must be completely fdled 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 o areas, and gwing a detailed description of layout of property must be drawn on the diagram which is part of th~s applicatior 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 permi shall be kept on the premises available for inspection throughout the work. e No budding shall be occupied or used m whole or in part for any purpose whatever until a Certificate of Occupanc 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 th Budd,ng Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances c Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describec The applicant agrees to comply with all apphcable laws, ordinances, building code, housing code, and regulations, and t admit authorized inspectors on premises and in, buildings for necessary inspections. (Signature of applicant, or name, if a corporation) ......... ........... (Address of apphcant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde .................................... Name of owner of premises ..... ...~..O..~(~.~'...~....'~.. ....... ..?... ...... ?(...~....~.....~'....~.....~:...~.. .................................. If apphcant is 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. M ~ ( / Location of land on which proposed work will be done ap No ................................... Lot No ..... ./. ............. Street and Number ........ .~..J~t...~....L:./~..IJ~...Z~. ...... K~...~..: ....................................................... ~.,~.O....O .~..kt~...C:.....~. .... Municipality State ex~sting use and occupancy of premises and intended use and occupancy of proposed construction' o Ex,siting use and occupancy ......... .~ ...... ...~/..~iiiii~~i~iiiiiiiill b Intended use and occupancy ................................................................. 3 Nature of work (check which apphcable) New Budding .................. Addmon ................. Alteration ...... Repmr .................Removal .................. Demohhar ........ Other Work ......... 4. Estimated Cost .......................................................... Fee ~ . .......... (to be prod on filing this applicahon) 5 If dwelling, number of dwelling units ........................... Number of dwelhng umts on each floor ........................... If garage, number of cars ............................................................................................................................ 6 If business, commercml or m~xed occupancy, specify nature and extent of each type of use ........................ 7. D~menslons of ex,sting structures, if any. Front ......................... Rear ............................... Depth .................... Hmght ........................ Number of Stones .......................................................................................................... D~mensions of same structure w~th alterations or additions' Front ....................................Rear .................. Depth ............................. Hmght ................ Number of Stones ............................ 8 D~mens~ons of entire new construction: Front ................. , ................ Rear ........................... Depth ................. Hmght ................ Number of Stones ................................................................................................. 9. Size of lot' front ................... ........................ Rear .............. ~.-.~..~ .................. Depth ...... ~.....~...~ ............ 10 Date of Purchase ................................................ Name of Former Owner ....................................................... ! I. Zone or use district in which premises are situated ................................................................................... 12 Does proposed construction v~olate any zoning law, ordinance or regulabon' . ...................................................... 13 Wdl lot be regraded .......................... Wdl excess fill be removed from premises: ( ) Yes ( ) No 14 Name of Owner of premmses ~O O .tl 7'...T.. ~'/~ 0 -~'/~/-Address ~.~..~. IL//.'.~...~.~?Phone No. ~.~..67...-..~.~ ................................................. Name of Architect ........................... Address ................................ Phone No ...................... Name of Contractor .............................. Address ................................ Phone No ...................... PLOT DIAGRAM Locate clearly and d~st~nctly oil bulld=ngs, whether ex=sting or proposed, and indicate oil set-bacl dimensions fron property lines Gwe street and block number or descriphon according to deed, and show street na~ ~es and in&cab whether interior or corner lot STATE OF NEW YORI~,z COUNTY OF ~ ..d1¢~...~r....f'-'''' ..-Z,...~....~ ..~.....~...~...~..~ ,/./.~...~....~.,.~.,..~..'~... ~..O.~...~....~....~. ............. be,ng (Name of individual signing contracf) duly sworn, deposes and says that he ~s the opphcor above named . (Contractor, agent, corporate officer, etc ) of said owner or owners, and is duly authorized to perform or have performed the sam work and to make and fil this application; that ail statements contained m th~s application are true to the best of his knowledge and behef; an that the work wdl be performed in the manner set forth ~n the apphcatio, n filed therewith. Sworn to befor~ me this ' /'~ /') // 747. ~' (~g~,C&ture of applicant) JUDITH T. BOKEN Nr'fcry Public, S~ate of New York I ~ 52-0344263 Suffolk Counta.,~r Com, m~ss~an Exp~re~ Mar~b ;~0r lP~/