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Home My WebLink About7921-z l~OE~[ NO. ~ TOWN OF SOUTHOLD BUILDING DEFARTMENT TOWN GLERK'S OFFIGE SOUTffOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 7921 Z Permission is hereby granted to: ...~.~......~.~'.~.~...L~..~ .......... ~.~.~..~..r ....... pursuant to application dated ....................................................... 19 ........ , and approved by the Building Inspector. Fee $...L.?. .............. Building Inspector 'ro~N OF SOUTHOU) BUILDI~ DEFAILTMINT Application No. APPLIGATION FOR BUILDING PERMIT INSTRUCTIONs a. This al~ldication must be completely filled in by typewriter ac.in ink and subm, itted in triplicate to the Building I~q?ector, with 3 set~ of plans, accurate plot plan to scale. Fee occord,no to schedqle. b. 'Plot plan showing Iocatio~ of Iot'andof buildings on premises~ reJa~onship 'cd adjoining premises or public stree.~, or areas, and giving a detailed description of layout ofpreperty must be drawn on the diagram which is part of this applicat,on. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Buiid!ng Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspect,on thrbugh~It the work. e. No building shall be occupied or used in whole or in part'for any purpose whatever until a Certificate of Occupancy shall have been granted by the IB~llding inspector. APPLICATION IS HEREBY MADE to the Building Departrrmnt for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk ~ty, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildj~ll, additions or alt~ions, or for removal or demolition, as here n described. The ?..pplicant agrees to comply with .all ~!icable laws, ordi~es, building code, housing code, and regulations,' end to admit authorized inspectors on prem,ses ~ ,in buildings for ~ecessary inspections. , (Signature of appl,cant, or name, if a corporation). '/ .......{^ddress of ~l~u¢on. '" State whether opplicant is owner, lessee, agent, amhlt~t, engineer, general contractor, electrician, plumber or builder. ............................... ........................................................................................................ i:, ....... ;:,:.. ................ Name of owner of premises ....... ................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's LFOII~ No ............................................. Other Trade's License No ............ ~ .................................. Location of land on which proposed work will be done. Map No.: ........................................ Lot No ......................... Street and Number .'. ......................... i~.¢~.~.~'.$.~1a~ ...... J~lt.~..~ .................................................................... Municipality State existing use and occupancy of premises and intended use and occupancy of preposed construction: a. Exisiting use and occupancy ........... ~.~:.~.J~.g~,~,.l~.C,.~, ............................................................................... b. Intended use and occupancy ......... ~.A~,~.,,~.~.AN.~,. .................................................................................. 3. Nature of work (check which applicable): New Building.· ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ....,,,~..~.x~.~.d. ........................... ' (Description) 4. Estimated Cost ............. ~. ........................................... Fee ........ /..0.,.~.~. ................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ....... ~ ................. Number of dwelling units on each floor ...-.,.'~. .................... If garage, number~of cars ..................... ~ ......................................................... t ........................................................... 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 ....~....~. ............. Height ....... .~../. ....... Number of Stories g. Size of lot: Front ....................... Rear ........................................ Depth ................................ ,O.'~T~)ate of Purchos&, ii..~iiiiii ~i~iiiiiiiiii ...................... Name of Former Owner ........................................................ 11. Zone or use district in which premises ore situated ..................................................................................................... 12. Does proposea construction violate any zoning Iow-;'~rdinonce or ragu[arian: ...... ~. .......................................... 13. Will lot be regroded ...... ~..O ............. Will excess fill be removed from premises:- ( ) Yes (~') No 14. Name of Owner of premises ....~...~J~r..:y...~.~...~..~e-- - Address ..~.¢.~,,~.~'~.hL,.. Phone No. Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ...................... PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate all set-~oack dimensions from property lines. Give street and block number or deSCription according to deed, and show street names and indicate whe~tber interior or corner lot. lq V e., STATE OF NEW YORK, [ ~ c COUNTY OF ................................ ............................... ......... ............ ~y~,ei.ng duly swos;n, deposes and says that he is the applicant (Nome of individual signing contracf) above named. He is the ........................... ..~....~....~.'..?..~.. ............................ .". .......................................................................... ~ ........................ (Contractor~ ogent~ 'Fora?qt,? officer, etc.) · f of said owner or owners, and is duly authorized to perform or have per armed the sa~d work and to make and file this application; that all statements contained in this a~jcetion, are tru?. to the best of his knowledge and belief; and that the work will be performed in the manner set forth in ~he application filed therewith. Sworn to before me this of , ........ ....... (Signature ~f applicant) JUDrl~ T. BOL'IE~ Notary Public. Slate of New Yor~ No. ~2-0344963 Surfak County~ Camm ssion ~xpJrea March 30, I~_~J .... ~'_ ......