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Home My WebLink About7967-z FO~,~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFIGE SOUTH'OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 7967 Z Permission is hereby granted to: ~.u~...:~.o ~ ...:.e.,:~ce...C~....~/P~..3;oh~.. ............ .~e. ~.t,. :L~:~,.c~ ............................................. to ,..~ ~.,':~ ~ Y~... ~ ~-,..~. ~Li~.~.~ '~ ~-t~ ..~ .. £ ~:...~ h-~ i~.. link...£ene, in~ ~ ...E ~-~n.~.. ~id~..&..~'~a.~...P, L · at premises located at ..~.~,~&..~,.v.o .................................................................................................. ................................................................. ~ c~u~oq'd'"" f~' ~Y'~' .............................................................. pursuant to application dated ...........................I.,.~.D, ....... ..~0 .......... , 19...~?.~., and approved by the Building Inspector. Fee $.1-. ,5'.,.DD. ........... FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ~×am,ned ........................... ...~....~ C~..O.. ....... , ~9.2.~ " ........................................ , 19 ....... e~it No ................................. Disapproved a/c ........................................................................ .............................................................................................. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS ^pplicat,on ~o...2.]...~...7. ............. a. This application must be completely filled in 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 buildings on premises, relationship to adjoining premises or public streets m areas, and giving o detailed description of layout ofproperty must be drawn on the diagram which ~s part of this application. c The work covered by this application may not be commenced before issuance of Building Permit d Upon approval of th~s application, the Building Inspector will ~ssue a Building 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 Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, 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, ordinances, 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) (Nome and title of corpora~;e~officer)~ State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder If opphcant is a corporate, signl~fure of duly authorized officer. ~ Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... ~ r-~Z,~_~ Location of land on which ro osed work will be done Mo .... at No ~ P~..~ ~.~ P .......................................... Street and Number ...... J..J. ................... ~ .................................. Municipality State ex,sting use and occupancy of premises and in?nded use and occy'J~ncy of proposed construction: ba Exis,ting use and occupancy Intended use and occupancy ........... ?_ ~i 71'~.' ~...'"' :.~ iI ......... .~~..'...'.~O...J' .............................. .............. -'- ....................... //7 ............... i 3 Nature of work (check which applicable) New Building ................ Addition ................. Alteration ....... (to be po~d on flhng th~s apphcat~on) 5. If dwelhng, number of dwelling umts .......................... Number of dwelhng units on each floor ...................... If garage, number of cars .................................................................................................................................... 6. If bus~ness, commercial or m~xed occupancy, specify nature and extent of each type of use ......................... 7 Dimensions of ex~stmg structures, ,f any. Front ........................ Rear ................................ Depth ................ Height ........................ Number of Stories ........................................................................................................... Dimensions of same structure with alterations or oddmons Front .................................. Rear .................... Depth ............................... Hmght ......................... Number of Stones ............................... 8 D~mens~ons of entire new construction' Front ................. , ................ Rear ............................ Depth ..................... Hmght ................... Number of Stories ........................................................................................................... 10 Date of Purchase ..................................................... Name of Former Owner ....................................................... 1 1. Zone or use d~str,ct in which premises are situated ................................................................................... 12 Does proposed construction wolate any zomng law, ordinance or regulation' . ....................................................... 13 WHI lot be regraded ............................ Will excess fill be removed from premises. (_/ Yes ( ) No 14 Name of Owner of prem,ses ..~ .......... .~ Address Name of Architect .................................. Address ................................ Phone No ...................... Name of Contractor ....................................... Address ................................ Phone No ...................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ex~stmg or proposed, and indicate all set-back dimensions fron hnes G~ve street and block number or description according to deed, show street and ind~cab "9r°pertYwhether mienor or corner lot _ ~ __ . and names STATE OF NEWxYOR~.~ . /_ ~.~ ~ .~ COUN'D: OF )~4(~/6J~.....~.......f~ ~./~ ~~~...~..~..~~e,ng duly sworn, deposes and says that he ~s the apphcan (Name of indiwdual signing contracf) 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 said work and to make and f~l, this apphcahon, that all statements canto,ned ~n th~s apphcehon are true to the best of his knowledge and behef; am that the work will be performed in the manner set fo~h in the apphcat~on filed therewith ............... l :x2 :, - .... ............ ~ JUDITH T BOi;FN 7~' ~[~'~'~re of applic~' Y Nota~ Pubhc, 5~ ci 14ew York No 52-0344963 Sulloik Cggn~ ,~ Commission Expires March 30, 19~ ,4