The URL can be used to link to this page

Home My WebLink About9428-zTOWN BUILDING DEE TOWN GLERK'S SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) f N? 9428 Z Date : ............ : ........................................ , ........ Permission is hereby ............. : ....................... ; ............ '~'"~'~ ~r~ z/;';"~'~'~. ......... '~TF:;'~'""~'"';"~:'"7!:';;,'Z, at premises located at .......... :.; ............ ' ............... ~/~£ ~7.- .......................................................................... : ........................ ,..~..~ ....................................................... ~/19.../.?...,,and~ '-"~ approved by the pursuant to application dated ........................................................ Building Inspector, i~ -"- I~ee $ ........................ ;,: BUi1'aing,i I~spector TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE $OUTHOLD, N. Y, Ois~pproved ................. ~-.~-;;~ ...................................................... (Buddm9 Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or~ in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans~ accHrate plot plan to scale. Fee according to schedule. b. Plat plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets os areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment for the issuance of o Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and Other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal, or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or nome, i~ Box 68, Or$ent, N.Y. 11957 (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. oTsneZ' Name of owner ~f r~ ~,,~ Katherine M. Latha~ 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 License No ............................................. Other Trade's License No ............................................... ]. Location of land on which proposed work will be done. Map No.: ........................................ Lot No ......................... Street and Number ....2.0.~...~...I~.~.3CD,~R...~.~B,~....0~;t~XLt.,...~T~..,.~ ............................................................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy Reeldential b. Intended use an~ occupancy .......... ..~..e..~...~.~..e..t?..t.~a..]: .................................... ....................................................... 3. Nature of work (check which applicable): New Building'. ................. AdCition .................. Alteration ................ 4. Estimated Cost .~.~.~.Y.~.~ .......................................... Fee ........~.'. /.~ ........................................... (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 ............. · .................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existinggtructures, if any: Front ............................ Rear ................................ Depth .................... Height ..~...~.~.~.~... Number of Stones ................................................................................................................. 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 ..................................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase over ~Q..~., ............. Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ...... ~.~ .............................. 13. Will lot be regraded .X~...6=a~e~ ..... Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises .K&~h~rl~...~..~m ....... Address ..~.$.~.~.~...~.~.~.~.. Phone No. Nome of Architect .............................................................. Address ................................ Phone No ....................... self ~om~ o~ Co~mc~o~ ............................................................ Add~ess ................................ Phone No ....................... PLOT ~oc~e de.dy ~nd d~d~cd~ ~ h~d~gs, whe~he~ ex~dn9 o~ proposed, c~d ~nd~c~e ~ se~-~ck d~e~s~o~s ~om p~ope~ ~es. G~ve s~ee~ e~d b~ock ~be~ o~ de~cd~on *cco~d~ ~o deed, ~nd ~how ~ee~ n~es whether interior or corner Iol. STATE OF NEW YORK, lc c COUNTY OF ...~lff. O1]C ............ ~°'~ ....... ~,~tlCt~.~l~et..~,..I~.t,l~,St~ ............................................ being duly sworn, deposes and says that~e is the app~icam (Name of individual signing c~ntrac~). above named. ~le is the ......... ~ ............................................................................................................................................................ (Contractor, agent, corporate officer, etc.) ~aid o'~i~ei~, and is duly authorized to perform or have performed the said work and to make and file this application; that al~ statements contained in this appiication are true to the best of ~knowledge and belief; and tha~ the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ' ................. co.. ' ........ ~0. 52-464322t, Suft~lk Term Bpire~ Marck 30,