The URL can be used to link to this page

Home My WebLink About7913-z ~OILM NO. ~ TOWN 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 AUTHORIZ..ED) N9 7913 Z Permission is hereby granted to: .~...n..~...?..~.~......~,~,L.......~.,.....~.O. .... ........... . ? -r premises located at ..................................................................... ) ................... ; ................................. pursuant to application dated ................................................ .?..., 19Z.?.., and approved by the Building Inspector. Fee $ ........................ Building Inspector i =.- LAU:~-, ----. .:~ To~vk~ .')F o = ;rzo~ IvO~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ~prov~ ................ .~...-.d....~... ,~SL.. ,erm,t ~o.~l.~. ...................... Disapproved a/c ............................. ~... ........................................... ................................................................... ............... APPLICATION FOR BUILDING PERMIT Date ............................. , 19 .......... INSTRUCTIONS a Th~s apphcat~on must be completely filled m 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, areas, and gwing a detailed description of layout ofproperty must be drawn on the diagram which is part of this applicotio~ c. The work covered by this apphcation may not be commenced before ~ssuance of Building Permit d. Upon approval of this apphcation, the Building Inspector wdl issue a Budding Permit to the apphcant. 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 issuance of a Building Permit pursuant to d Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances. Regulabons, 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. .............. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, ~e ~ architect, engineer, general contractor, electrician, plumber or bud& A~ UT ...... ....... ........................................................... ~ .................................................................... t. ~x.:.~ 5 ..... ~Z"i'~' ............ If applicant is a co~orote, signature of duly authorized officer. ~ n ~ ~ g ~ (Name and title of co~orate officer) Budder's License No ..................................................... Plumber's License No ................................................ Electrician's License Other Trade's License No ............................................... _.__ __ Location of land on which proposed ~,~iJ). be do e~./Mop/:. No'. .................................... /_. ~ U /~'Z:' /__ Lot No ..................... Street and Number ........................................................ j ............................................................................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a Exisiting use and occupancy ....................................... b. Intended use and occupancy ......................................................................................................................... 3. Nature of work (check which applicable). New Building ................. Addit,on ................ Alteration ............. Repmr .................. Removal ............... Demolit~or ................ Other Work ........................................... · /.~ ~ (Description) ~j (to be prod on filing th~s apphcat~on) 5. If dwelling, number of dwelling umts ........................ 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 D,mens,ons of ex~sting structures, if any: Front ........... ...... Rear ................................Depth ...... (..~,....~ Height ......... ./...~ .......Number of Storms .......................... J. ............................................................................... D~mens~ons of same structure with alterations or addmons: Front ............... ..~...~.. ............ Rear ................... Depth ........... .~.,..~.. ........... Height ...~...~;; ......... Number of Stories ............ / ............... 8 D~mensions of entire new construction Front ............... .~... ........... Rear ............................ Depth ...... .~'~...~..... Height ....... ./...."~... .... Number of Stories ............... ./.. ......................................................................................... 9. S,ze of lot Front ....................... /.....~...~O.. ................ Rear ......... ................ D_~epth .~.~.]_/. :~....~...~.... .... 10. Date of Purchase ................................... ~. ................ Name of Former Owner ........................................................ 1 1. Zone or use distr~ct in which premises are situated .................................................... ~...~, .......................... 12 Does proposed construction violate any zoning law, ordinance or regulahon: ........................................................ 13 W~II lot be regraded ......... .~..~....~J....~ilLe~:e~ ~llJJbe removed from p~r~i~:l~ 5) Yes ( ) No 14 Name of Owner of premises .................................................... Address .....................;,., ........ Phone No ....................... Nome of Arch~tect ~1~ I~ I~Ct~ ~ l~e~/~l,~,' l't.~,r~r~.~ ~-~ -~,.~ .................... .... ~'d1't~t""'l~[ '~,'~'E'~ .......... a ssc.,~t.~.U,?~,.,,~.~,ff ..... rnone'~o.' ~ & ~ 8 Name of Contractor ............................................... Address ................................Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ex~stmg or proposed, and indicate all set-back d,mens~ons frorr property hnes Gwe street and block number or description according to deed, and show street names and indicate whether interior or corner lot STATE OF NEV~-~-r~c~ COUNTY[~I~ .-~...~'l.'~'. j.J~. ....... ~.fJ~'~ g6 ht A ~ ................................................................................................ being duly sworn, deposes and says that he is the apphcam (Name ~fjnd~wdg~ signing .~ntra~ He ,s the ............................................... of said owner or owners, and ~s duly authorized to perform or have performed the said work and to make and f~lc th~s opphcot~on; that ol~ statements contained in this opphcation ore true to the best of his knowledge and behef; that the work will be performed m the mon~er set fo~h~n.t~apphcat~on filed therewith. Sworn to bede me this ~ ~ '~ ~ /~ ~oto~ Public, . ................................................... Coun~ ............................................................................................ J~D~TH T. ~OK~M {Signature o~ ~pplic~nt) NoI~ Pubhr, Slate of ~dew York No ~2-U344~63 Suffolk Cou~ Commission Expires March 30~