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Home My WebLink About7937-z I~ORM NO. ~ TO~VH OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 7937 Z Permission is hereby granted to: .~.a...~....~.n..~.e....~.~.e.~ .......................................... ............... ~,a~ho.~ ............................................. to. e~' e~ ~...a~-. ~a. 'J~-~a ~L~-- -~r,e -5.~ g..-.- a.~ · per- '& ppl-$e a-~ ~u3: .......................................... at premises located at ..... .~t.--~.....~4~t;~;...Pa~: .................................................................... ...................................................... ~80.....~a~;]~. il...Ro&d. ......... Sea.t, ho3~ ..................................... pursuant to application dated .......................t~:~. ....... :~.~ ............. , 19..~..~., and approved by the Building Inspector. Fee -$~ -~.00 ............ Building In'~spector ~ Approved ........................................" ~I/ ' //~ i FOII, M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 192~... Permit No.-...~....~..~....7....~.... ..... APPLICATION FOR BUILDING PERMIT Date ...!...~.. ...... ..J)..../?...~...~) ................ , 19.~2....~.. INSTRUCTIONS a. This applicabon 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 locahon of Jot and of buddings on premises, relationship to adjoining premises or public streets, areas, and giwng a detailed description of layout ofproperty must be drawn on the d~agram which is part of th~s applicatio, c. The work covered by this apphcation may not be commenced before ~ssuance of Budding Permit. d Upon approval of this application, the Building Inspector will ~ssue a Budding Permit to the applicant. Such perm 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 Occupan, shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the ~ssuance of a Building Permit pursuant to tJ BuJdmg Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances . Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe The applicant agrees to comply with all applicable laws, ordln, ances, building code, hou~l code, and regulations, and ....... .,, ..... .................... ~_._~g. ~ applicc~nt, ~r n_ame,_Lf a corporation) ...... (Address of applican'lO / State whether applicant is ow~lessee, agent, architect, engineer, general contractor, electrician, plumber or build,~ if applicant is a corporate, s~gnature of duly authorized officer. (Name and title of corporate officer) Builder's bcense No ..................................................... Plumber's License No ................................................ Electrician's L~cense No ............................................. Other Zrade's License No ............................................... 1 Location of land on wh~h prc~Rc~ork w,l, l~e~d~r~,e. Mc,~ No k~..U./ik].~.(~.'~.:I .... !".~..':.. Lot No ..................... ...... ............ Street and Number~..b~ ...... )..~.f..~:t..I..)J....)...~..d ........ ~'ut"~'~"~' C'~'"'"'~"'~'" /~unicipolity 2 State existing use and occupancy of premi~es-~d intended use c~k~k~ccupancy of proposed construchon: a Exis,ting use and occupancy ................ ~.~.....)...U~'.~. ........ ._ ..~..J~d..~...L.l..J./~ ../~. ............................. b Intended use and occupancy ................................................ ..~.~...~. · .~J~ .J~.~ ~./~ ........... 3. Nature of work (check which applicable) New Budding ........... Addition .................. Alteration .......... Repair .................. Removal .................Demoht,or ................ Other Wa rk~.~. C. ~..[."'~...[.~ ~. L. ~..- ~. 1.~. ~v,,~_~. , " 4. Estimated Cost ..... ...~..~','~..,.~.~ ................................. Fee .......... ./.~....,.~.~. .............................................................. (to be pa~d on filing this applicahon) 5. If dwelling, number of dwelling units ........................... Number of dwelhng un,ts 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 exmting structures, if any. Front .......................... Rear ................................ Depth .................. Height ........................ Number of Stories ............................................................................................................ D~mens~ons of same structure with alterohons or addmons Front .................................. Rear .................... Depth ................................ Height ......................... Number of Stories ............................... 8 D~mensions of entire new construchon' 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 ore s~tuated ............................................................................................. 12 Does proposed construction wolate any zoning law, ordinance or regulahon ........................................................ 13 Will lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes ( ) No t4 Name of Owner of prem,ses ................................................. Address ................................ Phone No."~.~/.,..~..'...]..~..~.~_ Name of Architect .................................................... Address ................................ Phone No ...................... Name of Contractor ............................................. Address ................................ Phone No ...................... PLOT DIAGRAM Locate clearly and distinctly all buddings, whether existing or proposed, and indicate all set-back dimensions fron property hnes Gwe street and block number or description according to deed, and show street nctmes and in&cot: whether interior or corner lotI ~ - ~ : '-,~ ~ '*/ ' ~' COUNTY O~~~..:~3'.~ ,'Z'~/~[~t{,}} )~d ~ ~teposes ........... ~.~.~../~ ................... ~. being duly sworn, ana says that he is f~'~phcan ¢ (N¢~ oh~dividual signing contract) above named ¢ He is the .................................. ~ ......................................................................................... (Contractor, agent, corporate officer, etc ) of said owner or owners, and ~s duly authorized to perform or hove performed the said work and to make and this apphcahon, that all statements contained in this opphcat,on are true to the best of h~s knowledge and behef, that the work wdl be performed in the manner set fo~h m the ~pphcation filed therewith, a Sworn to b~fore me this ~ _ ~1 /~ / ~) ~ dayof ~ , 19~ L '-';;;'"";;"; ....... .......... ....... t ....... ............ ....................... ............... .~)///` ~ (SJgnatureofapphcan0