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Home My WebLink About9226-z 1~0~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ ¥. BUILDING I~ERMIT ('FHIS PERMIT MUST BE KEPT ON TH.E P~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 9226 Z Permission is hereby granted to: //~(~, . .~ ,, ................ .;=~....~ .......... _ _ ........... ~.~......~~ ........ ~.~...~,...~:: ........ .C~.L..~..~...~z~-~J at premises located at ...........~.//~...... ~/..~."......~,~ .................................................. Building Inspector. Fee $./....~..~..~ ..... r.¥~..ESS FI LLi'e~,, TO REM'~VC '",-' - FROM ABOVE PREMISES B~ REGRADING LOT ~ DRIveWAY CONSTRUCTION ~ C: .~P.)OL CONSTRUCTION ~ '~ - ,~ ct~ ~,R CONSTRUCTION ~ - Building Inspector FORM NO::.Y TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN .CLERK'S OFFICE SOUTHOLD, N. Y. N Examined ........ . .�� ............ •1..., 19. � Application No. ............................. .. . .....�`. L....., 1 .., Permit No. Approved_ :. ............� 9�. . . Disapproveda/c ..:... ......... .. ..... ................................................................................\.....�.................................... .......................... ::.Y.... . 7inspector) APPLICATION FOR BUILDING ERMIT mc. . Date .................... ...... ..........., 19. .�...U 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, 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 or areas,.and giving'a detailed description of layout of property 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. T .e. No building sholl.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. J 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 S 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. If °( . .. .... .... .. ..C: ................. . .. . .. . . ..... . ................. (Signat a of applicant, or name, if a corporation) ��~ ....... '�v Q **: * ................(................ (Address of applicant) State whether applicant is owner, lessee, agent, architect,'engineer, general contractor, electrician, plumber or builder. ......................................... ......4.. .................. . ................................................................... ................. Name of owner of premises .. ... .. .......:.�-`'/..:. ... ...:�.......................................................... 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. ............................................ S OtherTrade's License No. .............................................. 1. Location of land on whi proposed work will be._done. Map No.* . ....................... ........ Lot No. ;. :: ..:............ Street and Number / .. ............. .....�-a__1 -.......... .......... .............................................. ................ ...`"J........... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed .construction: a. Exisiting use and occupancy .:......... �°� ........................... .,.,,.. ��\�................ b. Intendedf use and occupancy . ..... ..:. �.. .�� .... .......... ` 3. Nature of work (check which applicable): New Building. .................. Addition .................. � ` � Repair -.-__-- Removal --r��.-.. Den�oitioc.'--....--. Other \A/o�k .�^n��-J... � 'L Estimated Cost ...............................................`.......^..... e -- .-.........---'---------.-'^--~'.'.---------.. (to be paid on filing this application) 5. If dwelling, number of dwelling units -.-.��.----..Number ofidwoUinQ units on each floor ._-.-------.. � Ifgarage, number ofcars ........................ ................�'-----'r^~--'.--~-^-'~-^~'^~.~`~`'--~--' --.. . ' � \ 6. If business cnnnnnavcio| or mixed occupancy, specify nature and extent of each type of use &n.... .--- 7. Dimensions of existing atructures ifony� Fr�` -_---..��.--- Rear -_'..-_-,...--.--- Depth ..-.^-.-.-.. -- - - Height -----.----- Number of Stories ---.-.-----_--__-_.--_.------...-..^'__--.-~------. Dimensions of oonne structure with alterations or additions:' Front .................................... Rear ............................ De-oth ----------- Height .......................:....Number of3tories ................................ 8. Dimensions of entire new construction: Front .........iy-�-',.�"_-.-- Rear ....................... . Depth �~� - ..... Height .................... Number of Stories -.--.--._,.--.___-_---.--.--------------_---. 9. Size of lot: Front ........................................................ Rea .......................................... Depth ................................ 16., Ooto of Purchase ..--..-----------------Nan�a of Former Owner ---_-..-'.'.~-'...,..-~-.-_---.. y` . ll. Zone or use district in which premises ova.oituotod ------w ..... ......................................................... 12. Does proposed construction violate any zoning low, ordinance or regulation: .......................................... 13. Will lot be regraded --- Will fill bm removed fron� ( } Yes � � No l4� NonneofO�nerofprennisau --�*��~~=�'.-~. ��drmss ..�� Phpme.��m. `..~,,,........,.-,. ^^ x ' Name of Architect -----.. .-...-' Address '..-..'~......~.,...~....Phone No. .,.~.....'.....'. Nome of Contractor ----. .......................................... -' Addreso ................................ Phone No ..............,.~^ PLOT DIAGRAM ' Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according tu deed, and show street names and indicate whether interior or corner lot. IWO I-L pit -TATE OFNEWYOR�. ( �OUNTY OF .-------.---,)�-- / -----------------_._------ .-----.----6eing duly sworn, deposes and says that he is the applicant (Name of individual signing controct . � � . above named. � Heis the -..---.-------~--^-'--'-~----'----------^°-^`~----`---~~^^~^~^^^~~^~'-------- (Contractor,- agent, corporate officer, etc.) of said and i duly authorized � r� or have par��e �a said work, a� � make and f||o thisapplication;�� that ,all statements contaiined in this ' ' 000S are true to the bast of his knowledge and belief; and thor work-\wiU bdporformad in the manner set'-forih in the � |icotion filed therewith. ' Sworn to before me this ` `� ^x -~~--~-~-%r-`~-~- ---------------~'^~~^---� BUU.~IN~ DIPAIrrMINT ~OU~HOLD, N. Y. ,~ro~ ....................... , ................ , ~y..,..... Pan~.t ,o..*...~ ............................. Disapproved a/c .............................................................. Application No. ~ '~' ~ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application muSt be completely filled in by typawriter o~. in ink and submitted in triplicate to the Building Inspector, with 3 ~set~ of pkms, accurate plot plan to scale. Pee.accarding to schedule, b. Plot plan shOWing location of lot and of buildings on premises, relationship to edjo n ng. premises or publ c streets or areas, and giving a detailed description of layout ofproperty must be drawn on the diagram whmh is part of this application. c. The work cover, ed by this application may not be commencedbefore issuance of Building Permit. d. U.pon approval of this aPPlication, the Building Inspector will ssue a Building Permit to the applicant. Such permit snail be K~pt on the pram ses available for inspect an throughout the work. e. No building shall be occupied or used in whole or in part for any purpme whatever until a Certificate of Occupancy Shall have been granted by the Building Inspector. ~ for the issuance of a Building Permit pursuant to the APPLICATION IS HEREBY MADE to the Buildina De~rtment Building Zone Ordinance of the Town of Southold,'Suf~i~ ~.ounty, New York, and other applicable Laws, Ordinances or ~egulati.o. ns, for the construction of buildings, additions or alterations, or for removal' or demolition, as herein described. i i~e 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 inspect'on. (Address of applicant) State whether applicant is owner, lessee, ager~t, architect, engineer, general contractor, electrician, plumber or builder· .............................................. T~Z; ...... ~'""~E'.' ........................................................................................................... Name of owner of premises ...u~...(..j...~.;-.......~..... ~-~..~.; .............. If applicant is a coq~orate, signature of duly authorized officer. (Name and title of co~orate officer) Builder's License No. ~v.~,,.,~~ Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... ~ Locat on of land on wh' - osed work ' be done Ma ' o · - ~(~ ,nicr/-propos ~ . p~l~ .: ..... ~.~ ............... ,,~ ....... ~... Lot No ......................... Street and Number Z~~ .................. : ....... ...~...~.~.... ........ ~:...~.. ................................ Municipality State existing use and occupancy ofiLoremises and intended us~,and_occupancy of~raposed constzuction: a ~xst n use and o~cu o ..~....~- ,4__ ~, ~ ~ ~ ~ · g PncY ............................................................................. ~/ .............................................. 3. Nature of work (check which applicable~ New Building,. ................. Addition ...... ~ ........... AY~ration ~ ............... Repair .................. Removal .................. Demolition ............ ,..,.. Other Work .............. ~.....~ ............ / ~/~ ~ (Description) 4. Estimated Cost ....................................... ~ ............. 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 ........ E. ................... 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Numberpf Stories ................................ 8. Dimensions of entire new construction: Front .................................... /.~ t ~ Rear ............................ Depth ........................ /9- ~ ,~ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10~ Date of Purchase ........................................................ N~ of~j'~m~.~,~Owner ........................................................ 11. Zone or usedstrct nwhch remsesorestuated ~,--v ~., - 12. Does proposed construction violate any zoning law, ordir~nce or regulation: .......~...i..~.. ......................................... 13. Will lot be regraded . ........ ~ ............Wi?::~xcess fill be removed from?~emi~s: ~ ) Yes ( ) No 14. Nam~ nf C~wn~ nf n~,~ (~r~~'~ ~-~ ~ ~ ~ - ~ ~ --~ ........ ~ ........ ~ ...... "7 ................................. ~aaress ............................ mane No. ...................... Name of Architect ................. ~,~ .................................. "... Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGP~M Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and Show street names and indicate interior or corner lot. ~-C)/~'~,~'! 7//~ / V~--t('/ /~, OF NEW YORK, ~ S S ................................................................................................. being duly sworn, deposes and says that he is the applicam (Nome of individuol signing contracf) above named. He is the ............ t ................................................ .................................................................................................................... (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 file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn, tpJ~efore methis x~/ ~/~ /") /'~ /~ ,~ /., ~ ,~ / ~ 7'// ///(~ / ......... .: ................................ ...................... /z ......................................................................... ~'///~/ 4~, ~ CLt. t~ .// __ , ~ (Signature of applicant) '