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Home My WebLink About7964-z FOR~ NO. :~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFICE SOUTH'OLD, N. Yo BUILDING PERi'IT (I'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 796 Z Date ......................... ~1.~.'-"~O ............. , 19.~'.. Permission is hereby granted to: ~r..~...1~o~...~e~ee-.eo.- ......... I~t.t~ek. ................................................. to ..e~ae.t..aud...~L~a.~.~..4...f.t..~ha~...l~..fence.. at premises located at -.-~O.t...~..&-.J?.t~.~J..-.~J.~el~..lg~ .......................................................... .............................................. A~amo~acl~e.. ~.ve .............. ~e'at~o-l~ · · · - -1~-.-~.~ .............................. pursuant to application dated .........................J(a~.-....~O .............. 19..~.., and approved by the Building Inspector. Fee $..'J.~.~.(~ .......... FOB~ NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTNOLD, N. Y. P~ermit No. ~...~..Z~... D~sapproved a/c ......................................................... APPLICATION FOR BUILDING PER~IT Date .................. ~C...../...?. ............ , 19..Z..~.... INSTRUCTIONS a. Th~s applicahon must be completely filled ,n by typewriter or' in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buddings on premises, relationship to adjoining premises or public streets o7 areas, and giving a detailed description of layout ofproperty must be drawn on the d~agram which is part of this application. c. The work covered by th~s application may not be commenced before issuance of Budding Permit d. Upon approval of this application, the Budding Inspector will issue a Budding Permit to the applicant. Such permit 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 Occupancy 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 the Bu~Iding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulahons, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described The apphcant agrees to comply with all applicable laws, or&nonces, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) ........ (Address of applicant) State whether apphcant ~s owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises ........... ...~.. .............................. ./.,.~..J~../ ............................................................................... If apphcant is a corporate, s~gnature of duly authorized officer. (Name and title of corporate officer) Builder's L,cense No ....... ~1....~...(..~...~....~'...4~.......¢~....~ ..... Plumber's L~cense No ................................................. Electncian's License No ......................... ; ................... Other Trade's License No ............................................... ,O n . Locahon of land on which prj~osed work will be dane p '. ~ ..................... ]~o N ........ ..~..P. ......... Street and Number .......... ~~..~~ ...... ~..~-....~ ................... ~ ....... U Municipality State ex~sting use and occupancy of premises and ~n.*ended use anJ occupa~v of proposed construction: a Exisiting use and occupancy ............ : ~..-~.....~...~.~ ~.]:....~...~ ~- ~----.--/ ,, ......... .... 7, ........ u'ZT/7' _ ................ b Intended use and occupancy .................................................................................................................../~.7<~ ' '~" ~ ....... / - ' property hnes Give street and. whether interior or corner lot 3. Nature of work (check which applicable). New Budding ............... Addition ................. Alteration ............. Repair ................. Removal ................ Demoht~or~ ........ Other Work ................ 4 Estimated Cost ................. ~...~.....~....~. .................... lee ................ ..,~..~.....~. ..................................................... (to be pa~d on filing th~s application) 5. If dwelling, number of dwelhng units .......................... Number of dwelhng un,ts on each floor ...................... If gara§e, number of cr~rs ................................................................................................................................ 6 If bus,ness, commercial or m~xed occupancy, specify nature and extent of each type of use ....................... ? Dimensions of ex~sting structures, it: any: Front .. ~. ~:~.. ............... Rear ..... ~ .............. Depth ~ ...... He~§ht ........................ Number of Star,es ........................................................................................................ D~mens~ons al: same structure with alterations or oddit~ons Front .................................... Rear .................. Depth .............................. Height ......................... Number of Stories ................................ 8 Dimensions of entire new construction' Front .................. , .............. Rear ............................ Depth ................ Height .................... Number of Stories ..................................................................................................... 9 Size of lot Front ......... /...f~...l~. .............................. Rear ............./....O.....~. ................... Depth..~.~. ............ 10. Date of Purchase ................................................... Name of Former Owner ....................................................... 1 1 Zone or use district in wh,ch premises are situated ........................................................................................... 12 Does proposed construction violate any Tatung law, ord,nance or regulation: ........................................................ 13 W~II lot be regraded ........................... Will excess fill be removed from premises: ( ) Yes ( ) No 14 Name of Owner of prem,ses ../~.~N~....~..~....../~.!..~...~...I. ...... Address .~.?..~; .-~....~..'~.. Phone No..2~..~....~...~..~ Name of Architect ............................................... Address ................................Phone No ....................... Name of Contractor ............................................... Address ................................Phone No ....................... PLOT DIAGRAM Locate clearly and d~st,nctly all buddings, whether ex~stmg or proposed, a, nd ~ndlcate all set-back dimens~ons from ~ ~-mher or description according to de.~d.~ and show street names and indicate ..-~.~C~.~..~,~.....(.¢...~...~ . be,rig duly sworn, deposes and says that he ,s the apphcam (Name of mdiwdual signing contracf) above named He ~s the ....................... ~ .............................................................................................. (Contractor, agent, corporate officer, otc of said owner or owners, and ~s duly authorized to perform or have performed the sa~d work and to make and-file this apphcation; that all statements contained m th~s apphcahon are true to the best of his knowledge end behef; and tha~ the work wdl be performed in the manner set forth m the apphcatlon filed therewith. Sworn to.~be(~__~e me th,s ,JO' d y of ..., // /, N~,52"034496~ $uff~ ~ Com~J~tl~h E~pires March 30,