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Home My WebLink About7922-z FORi~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. ¥. Ne. BUILDING PERMIT (THIS PERMIT MUST BE KEPT O~ THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 7922 Z Date .......................... ]~]r. ....... ~ .......... 19..'~.~[. Permission is hereby granted to: ~.~e..~ omL..&/C.. ~uJ.s..~oaor. ............. .............. Jbe~a~.~. ......... $o~tl~o:L~ ....... to ~;~e.~t;..~ater~mea..~a~ ~.... ~..a[op~.o~ed.. la~...B~a~[..~ff... Appea.t s...~.96~...1.~1 ~ a~ premises located at .~texane~..~..:bor4lhoe..4~&~..o~eel~oa...T.~e~..~a.ta.tae~ ........ .............................. ]i/t~..~daze..aoaa..~[.cr27.) .... cateh~ae.....~,~, .................................... pursuant to application dated ................... ~.~......~. .................... , 19~...., and approved by the Building Inspector. Fee $.~.~.t.!~. ........... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTNOLD, N. Y. Examined ..... .~...~ ..... .~....~.. ...... proved ....... ........ ,92.t ,erm,t ....... Disapproved ~...~._... ~~ APPLICATION FOR BUILDING PER, AlT ............... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildi, Inspector, with 3 set~ of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings an premises, relationship to adjoining premises ar public streets ~ areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this applicatio, c. The work covered by th~s apphcation may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Budding Inspector wdl issue a Building 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 issuance of a Budding Permit pursuant to t~ Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances, Regulations, for the construction of buildings, additions or a]terations, or for removal or demolition, as herein describe, The applicant 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, agent, architect, engineer, general contractor, electrician, plumber or builde ...... ........................ Name of owner/of premises ......................... ~,.~....~..1....~. ...... /~...(J..l~..O....~.,~,. ................................................................... If apphcant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other 'l'rade's License No ............................................... ..!.~...~:~ .... Lot No ....................... 1. kocation of land on which proposed work will be done. MapNo. ~..~.~.~.~..~..,.:/ Street and Number ............. /~..L.i~..4~..C..~ ..... .~.~..~.~...O ..................... t. ......................... ..~.~.gi..~G./~.~.~...~/...[ ...... MuniCipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction' a Exisiting use and occupancy .............. ~,,...~.../..~2..~.4~v ................................................................. b Intended use and occupancy ............................................................................................................................. 3. Nature of work (check which apl New Building .......................... Alteration ........ Repa,r ............... Removal ....... ~ .... Demoht,or ............ Other Work .~..~...~./~,.~.. 4.'..~..~.~'..~.~../~'..~.~/ e~ N£u~, S~t~ PJg~31~'J ¢~,) ~rt r-/toH [',~J4/~wct (Description) 4. Estimated Cost ........... ..~...~..~.....~.....~...C.../~.. ......... Fee ../..~...~ ........................................................... (to be prod on filing th~s apphcat~on) 5. If dwelling, number of dwelling units ....................... 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 ex~stmg structures, if any. Front ................ Rear ................................Depth ................... Height ........................ Number of Stones .............................................................................................................. Dtmens~ons of same structure with alterations or add,hans. Front ................................... Rear .................. Depth ............................... Hmght ...................... Number of Stones ................................ 8 Dimensions of entire new construct,an Front ................. , ............... Rear ...........................Depth ............. Height .................. Number of Stories ................................................................................................. 9. S~ze of lot' Front ................................................. Rear ...................................... Depth ............................... 10 Date of Purchase ................................................... Name of Former Owner ...................................................... 11 Zone or use d,str,ct in which prem,ses are s,tuated .............. (..~.~...%.~t.ig~../~....~...?.~....f~ .............................. 12 Does proposed construction violate any zoning law, ordinance or regulation ...... .')(.i.g.~ ..................................... 13 WHI lot be regraded ............................ WHI excess fill be removed from premises: ( ) Yes ( ) No 14 Name of Owner of prem,ses .... ~.?..9.~.1..~ ..... J-~J.q./2..9..(b,. ....Address .~.~.~.~./~.¢~,~.~.. one No ...................... Name of Architect ...................................... Address ................................Phone No ...................... Name of Contractor . .~'.~.~ O ~- ... (~2.¢ ..~ L/J ............. Address .~.~.~..~....~.~..~..~... Phone No ...................... PLOT DIAGRAM Locate clearly and d~stmctly all buildings, whether ex~sting or proposed, and indzcate all set-back d~mens~ans fror property hnes Gwe street and block number or description according to deed, and show street names and ind~cat whether interior or corner lot STATE OF NE"v~//~,~:~.(,~/~X/ ~SS COUNTY OF ..zD3?~.~..~(.T,- ..... ~' ~ __ ................. · '/...~'~...~/~il.d. ii'.~ ......... /~ -- ~.~...Q.~../~.......Y~... ............... being duly sworn, deposes and says that he ,s the apphcar (Name of mdiwdual signing contracf) above named. ~ i~ He is the ............................ (~....6....~......~....~...,(JF....C.....~....(S......~. ....................................................................... (Contractor, agent, corporate officer, etc ) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and fiJ this apphcat~on; that all statements contained in this apphcahon are true to the best of his knowledge and behef; an that the work will be performed m the manner set forth ~n the application filed therewith. SworrL_t.o he, ere me this ..... · .~..('?..~. d of ........... ............. .................. , .~ (Signature of applicant)