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Home My WebLink About7907-z FOlt~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PkEMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 7907 Z Date ........................... ~ ...... 9 ............. 19...~.,~. 'Permission is hereby granted to: .......... .~.;~ ......................................... at premises located at ..... .~/.~..J~QD]R~J~..~J3~t .................................................................................. ............................................................... .c...u.~.o~..... ............................................................................ pursuant to application dated .......................~ ....... .~. ............. , 19..~.~.., and approved by the Building Inspector. Approved .............. .(.! ............ ~ ....... , Disapproved a~...~.,.~ TOWN OF SOUTHOLD ~ ,/:/~-~ -/ ~ BUILDIHG DEPARTMENT ~ ~~ ~~ TOWN CLERK'S OFFICE ~~ ~~ ~UTHOLD, N. Y. ~ ..... ' ............. ,~.2~e~t No...7.~..~....~ ..... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This apphcation must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildir Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildmgs on premises, relationship to adlo~nmg premises or public streets, areas, and giwng a detailed description of layout ofproperty must be drawn on the diagram which is part of th~s applicatio, c. The work covered by this application may not be commenced before issuance of Building Perm,t. d Upon approval of this application, the Building Inspector w~ll ~ssue a Budding Permit to the applicant Such perm shall be kept on the premises available for inspection throughout the work. e. No bu~ldmg shall be occupied or used in whole or Jn part for any purpose whatever until a Certificate of Occupanf 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 t} Buddmg Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances. Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe The apphcant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in, buildings for necessary inspections. .... ....... (S'g of applicant, or name, if a ;orpor;ii;~ ..... ..... ............. (Address of applicont) State whether applicant is owner, lessee, agent, architect, engmeer, general contractor, electrician, plumber or build, Name of owner of premises ........... ~..,..~L,L.'~.~.~."~.~ . ./~.~...~.....~...~l~]/~.,...~~f~ .~i..A,,/L~.~ ...... I n, rae n r f I ier If app ica t's a co1~9 t /~ig atu e o du y authorized off'c .//~, · .~....~..,....L~.~..~r~,~..~r. .... (Name and title ~f corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1 Location of land on which proposed work will be done. M~p No .............................. Lot No ................... Street and Number .......... .~/.~ ....... .J~Jl~...~.j~..~....(~'. ............................................ .~. ~.~li~..~ ~.~. Municipality 2. State existing use and occupancy of premises and m.~ended use and occupancy of proposed construction: a Exislt,ng use and occupancy ............ ...~.!.~.~..~.....~.l~.t.~ .... ~l.~.k~."~.~/~,~.../f ................. ..................... ~ ..................... ~.'. ........................ '...' .......... ~ ......... ~.~.~ .......... b Intended use and occupancy ::...~:... ~ 3.Nature of work (check which applicable). New Budding .................. Addition .................. Alteration ........ Repair .................. Removal .................. Demoht,ar, ................. Other Work ...~ .~.~.~.~,.~ ......................... ~ /~/)~-- ~ (Description) 4. Estimated Cost ....... ~'~ ""'--..~.~....1~......:......- .................. Fee ...................................................................................../..:. (to be paid on filing this apphcat~on) 5. If dwelhng, number of dwelhng umts .......................... Number of dwelling 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 existing structures, if any: Front .......................... Rear ............................... Depth .................. Hmght ........................ Number of Stories ............................................................................................................. Dimensmons of same structure with alterations or additions: Front .................................... Rear ..................... Depth ................................Height ......................... Number of Storms ............................. 8 D~mens~ons of entire new construction: Front ................ , ............... Rear .......................... Depth .................. Hmght ................... Number of Stories ........................................................................ 9 S~ze of lot' Front ......... .~..~.. ................................. Rear ....... ~.~..~,.~ ................ ~.Depth .... ~....~...~ ............. 10. Date of Purchase ........ ~..~ ........................... Name of Former Owner ~,~-'l~J..~.~....Jl~ ....... 11. Zone or use district in which premises are situated ...................................................................................... 12 Does proposed construction violate any zomng law, ordinance or regulahon ........................................................ 13 Will lot be regraded ...... ~.....~.: .......... .:.. Will e¥cess f,II be removed from premises.( ) Yes 14 Nome of Owner of premises .J~.,..~'/~..~S/.~....~. ,.~MJ~/,~.~ Address ..~~.t~.J~,~... Phone No. Name of Architect ................................................ Address ................................Phone No ...................... Name of Contractor J.~Jl~*..~ :..~'~J~..'!~..c~i~,j ...... Address ~J,/~.L~.~.~JI~ ...... Phone No. PLOT DIAGRAM Locate clearly and d~stmctly all buildings, whether ex~sting or proposed, and ~ndi¢ate all set-back dimensions fron property hnes Gwe street and block number or description according ~ deed, ..q~d show street names and in&cate whether intenor or corner, lot ~ ;~_ .......... ~ ' -, ,.-rC ---~, ,- , -.- ;,~.--;; :--,_---- --~. STATE OF NEW YORK, ~ S S COUNTY OF ~%.).~...~.~,,.L~,. ......... ~.""' .................... ..~J.i~i~C-~....~...,....j~-~C~..~?. ...................... be,ng duly sworn, deposes and says that he is the apphcan, (Name of indiwdual signing contract) above named. He ~s the ................................................ ..~.l~..l'.i/~l~.t'...t~ .................................................................................... (Contractor, agent, corporate officer, etc ) of so~d owner or owners, and is duly authorized to perform or have performed the sa~d work and to make and file this application; that all statements contained m this apphcohon ore true to the best of his knowledge and belief, on~ tho~ the work will be performed ~n the manner set forth in the opphcation filed therewith. Sworn to before me this ,,~, ~ __ .................. · ~.... day of ............ ~-.-.~u- ~., ........... , 19.7~. ~ q /2 Nota Pub,,c,. .................. Coun .......... ...... ...................... ~' -'~// U (Sig notu re of/pplicanTT"