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Home My WebLink About7946-z FOR3[ NO. 2 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 AUTHORIZED) N9 7946 Z Permission is hereby granted to:~ ...... ¥~.~..~....~~ ..... ~...,~~...~..~~,~, ~~..,~~.,.~ ..... ~....~~.~ ........................... ~. ............................ ~t .................. ~; ........................................ ~ __ t. .......... Building Inspector. Fee $~.~ Duilc~Jng Inspector FORM lqO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ...........~':. ............. .~..~. ......... , 19..((.... Permit No ...................... ..'~..... ...... D~sapproved a/c ............] ............. -:.~ .................................................. /. ........ ................................. .................... .......... . APPLICATION FOR BUILDING PERMIT Dote .................. ~.. ~c:j?~ ~ ........... , 19.7.5 ..... INSTRUCTIONS a This apphcation must be completely filled ~n 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 [at and of buildings on premises, relationship to adjoining premises or public streets c areas, and gwing a detailed description of layout of property must be drawn on the diagram which ~s part of th~s opplicotior c. The work covered by this opphcation may not be commenced before issuance of Building Permit. d Upon approval of this application, the Building Inspector will issue 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 occupmd or used m whole or in part for any purpose whatever until a Certificate of Occupanc shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Build,ng Permit pursuant to th Bu,ldmg Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o Regulations, for the construction of buildings, additions or a~terat~ons, or for removal or demolition, as herein describe, The applicant agrees to comply with oil applicable laws, ordinances, building code, housing code, and regulations, and t. admit authorized inspectors on premises and in buildings for necessary inspections. (S~gnature of dpplic6nt, o//hame, if a corporation) ........... ............ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or budder O~ Name of owner of premises ..... ~.~.l~r.~.cm..~.~or$~l~.4~oa~.onr.~no~ ................................................... · (Name and t~tle off,orate officer) Builder's k~cmse No ..................................................... Plumber's License No ................................................. Electrician's L~cense No ............................................. Other Trade's License No ............................................... 1 Location of land on which proposed work wdl be done Map No · . .................................. Lot No ...................... Street and Number ...1/ul~ll..]ilO~l .......~.....c~./.~::~.~-- ................................................ .Td~.~T.(l~l~ ' ........................ Municipality 2 State existing use and occupancy of premises and intended use and occupancy of proposed construction: o Exisitmg use and occupancy ....... J~OJll~..g,~Z~,T,g~ .......................................................................................... b. Intended use and occupancy ....... ~ .......................................................................................................... 3. ~ature of work (check which applicable). New Build,ng ................ Addition ................. Alteration .......... Repair .................. Removal .................Demoht~or. .............. Other Work ...~.C,~ ......................... (Description) 4. Est,mated Cost ..... j..~/.0.,.(~. ................................... Fee ~.,~.~Y.~.~ ........................................ (to be p&~d on filing thru apphcat~on) 5. If dwelling, number of dwelling units ........................... Number of dwelhng 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 ..... J"~/.(~ ......... 7 Dimensions of existing structures, if any. Front ....................... Rear ................................ Depth ................... Height ........................ Number of Stories ................................................................................................................. D~mens~ons of same structure with alterations or addmons' Front .................................. Rear ............. Depth ................................ Height ......................... Number of Stones ............................... 8. D~mensions of entire new construction: Front .......... ,58.,~.~e,t~ ....... Rear ............................ Depth Height ....~.t. ~.e.~.t~ .... Number of Stories ................................................................................................................ 9. S~ze of lot' Front ....... &);~.t,...~0..~'.~.~.~ ....................... Rear ..... ~.~..l~b~l~.~ .......... Depth ...~:~.Q.~t~t~ ......... 10 Date of Purchase .&~!~.g..,~.9~ ................................ Name of Former Owner .~,~Z~t~'..~,t~O,~ .................... 1 ! Zone or use district in which premises are s~tuated 12 Does proposed construction violate any zomng law, ordinance or regulation: ....... ]~.~. .......................................... 13 Wdl lot be regraded .... J~.~ ................... Wdl excess fill be removed from prermses: ( ) Yes (X) No 14 Name of Owner of premises .~.~ .1~.~.~..~!~..~..~..~..°.~t~1~.~. Address .~1~:~....~.~.~. ............... Phone No. ~/.'/,,~0,~ ..... Name of Architect .... ~10~. .............................. Address ................................ Phone No ...................... Name of Contractor ...... lT, e~ .1t1~ ~.~V ............... Address ................................ Phone No ...................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether exzsting or proposed, and md,cate all set-back dimensions fron property hnes Gwe street and block number or description according to deed, and show street names and ind~cat- whether interior or corner lot t,~tsrior lot. AdJoinJ Eas~ Marion Firehouse. Mt~ R~ad, East Marion, Town of ~ou%hold, County of ~b~ffolk and State of ~ew York, STATE OF NEW YORK, ~ COUNTY OF .~0[~ .............. fS S ........ ~A'~I~...~.~..I~I~,~)~. .................................................. being duly sworn, deposes and soys that he ~s the apphco.~ (Name of mdiwdual signing contract) above named. He ,s the ........................ .~'~ ................................................................................................................. (Contractor, agent, corporate officer, etc.) of sa~d owner or owners, and ~s duly authorized to perform or have performed the sa~d work and to make and fl this application; that all statements contained ~n th~s apphcet~on are true to t.~he best,of ~owledge and behef; ar that the work will be performed m the manner set foffh m the apphc~ion fil~ therewRh~ ~ I /q ~ Sworn to before me th,s ~ - ~ ~, , ]J~'~ ..... ~z'.Z~ ~ .......... ......... of ............... ...................... , ' , 'j, : ....... ...................... Co.. ................. '~~~~r~ (Signature of applic~t) Qualified in Suffolk C y Cert. F~ied ,n Nas~u Cou~y Oommlsston Expires March ~0, ~9~