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Home My WebLink About9238-zFORM TOWN O~F SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, FI. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PJ~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 9238 Z Permission is hereby granted to: ... ~,:~....~.....~. ~..~t~.e..~....~3~,.~.e ............ .................. w~z~. ~m~t..&. X~,m~...~t..., to ...~.~..,.~...~.~..~..~....~..~e. ae.~r~L.~...r.e.~...er~;t~.~....~/gZ~ .......... , ......... I':.~,~, ' ~-~,%~ ~':'~ ~i~r~rsuant ...... to application dated Building ~lnspector. at premises located at .~.eJ~'l,~J..~j~J...~c..[Jll~f~...]~ll~J ........................................... ~ ................. ..... ~ ................................................................. : ........................................................... ~t"~ .................. .... ~ .................................................................................................... ?V'~ .................... L ........ 'J~ ................ ................ '...~....,~.: ...... : ............ , 19~.., ~d apprqved by the Approved FO~ NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No .............................. Disapproved a{~ .......................................... ~ APPLICATION FOR BUILDING PERMIT oo, ................. ...... ..?......, INSTRUCTIONS a. This application must be completely filled m by typewriter or' in ink and submitted in triplicate to the Buildi[ 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 odloimng premises or public streets areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this applicatio 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 pern 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 Oocupan, 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 t~ Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances. Regulahons, for the construction of buildings, additions or alterahons, or for removal or demolition, as herein describe The apphcant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and ir) buildingsfor necessary~ "'~"inspecti°ns' ~~ (Sign ture of applicant, or name, if a corporation) ........................... ('X;J;JT;;';;T'~i;i;ii;;/,';i ........... r ....... , ...... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electricmn, plumber or builde ~3 ~N ~f~ .................................................... Uome o* owner o* pre~os ...... ~..0.!~.~ ...... G.:.../~I.~.~..H.,~..o......C....~..o...R...0....-C.~.~..~..~.c..d.~. ¢.p ............... If applicant is o corporate, signature of duly authorized officer. .............. i~;~;";';~i"iiii;'~;i'===================== ......... Builders License No ........ ~~'T.d~... ............... Plumber's License No ................................................. Electrician's License No ............................................. Other Trode's License No ..... .,.~,-..,~,, ....... Z ............... ~ ~ Locatmn of land on which proEosed work will be done. Map No ............... Lot No ........... Street and Number~..~..~]..~..~..)...[..~../~3L~.y.:&...Ex.u:......6.T........~..~..k..~...~..N.~...___. ,. ____.. _,. _ __~.,__-- ....... }~.., ..... ~.9....u~.....o..L.~.. ........... Municipality State existing use and occupancy of premises and intended use and occupancy af proposed construction' a Exisit,ng use and occupancy ....... !.~.~.!..~..~.I.~L~....~.. ........ ~¢~....~4Z, ................................................................. b. Intended use and occupancy ...... ['.~.~.[.~.~.l~..c...E.,~~l ................................................ 3. Nature of work (check which applicable) New Building ................. Addition .................. Alteration ............... Repmr ......... Removal Demolmor. Other Work J At ~ T~.a, L L (Description) 4 Estimated Cost ...... ~/....~¢.f~.~: ................................. Fee ...................................................................................... (to be paid on fihng this applicat,on) 5 If dwelling, number of dwelhng units ..................... Number of dwelhng umts on each floor ......................... If garage, number of cars ................................................................................................................................... 6 If business, commercial or m~xed occupancy, spec~ nature and extent of each ~pe of use ......................... 7. Dimensions of ex~st,ng structures, ,f any' Front ...................... Rear ................................ Depth .................... Height ...................Number of Stones ........................................................................................................... D~mens~ons of same structure with alterat,ons or addmons. Front .................................... Rear ......................... Depth ................... Hmght .................. Number of Stories .............................. ~'~struct,on. Front Rear ..... ~?.~..' .............. Depth 8 D,mensions of entire new ................... , .................. ~ .................. Hmght ...~.~... Number of Stories .............................................................................................................. 9 S~ze of lot. Front .". ..... //.. 'Z.g ............ Rear ...... Y..(.:..L.~g. .................... Depth ..~.~...~:.:..~ ........... 10 Date of Purchase ................................ ~.Z.~)~. ........... Name of Former Owner ..~[~.~..~.[~.....~.~.~..~.~ .............. 11 Zone or use distr,ct ,n which prem,ses are s,tuated ....~.t~ ~.].~.C.~..~]~'~ ~ ........................................................ 12 Does proposed construction violate any zoning law, ord,nance or regulation: ...... ~(.~ .......................................... 13 WHI lot be regraded ........................... W, II excess fill be removed from premises: ( ) Yes ( ) No 14. Nameofnw~f~;~)~;"i "i .~i~ f. [' t~ c~'~ g Address.......-..........~...........~"~ '~ ~'~ V o ......... ~ ............................................................. Phone N . , .................... Name of Architect ................... Address ................................ Phone No ...................... ~ome o( ~ontroctor ~ ~ I~E' kt ( ~ ~ ~, . ................ Address .~.'.:~:~...~?.~'~.~..~.~. Phone No. PLOT DIAG~A~ Locate clearly and d~stmctl~ all buildings, whether ex~stmg or proposed, and md~ate all set-~ck dimensions (roF prop~y lines G~ve street and block number or descrmpt~on according to 8ee~, and show street names and in~icot whefher tanrer)or oK comer )at t, .+ STATE OF NEW YORK, ! S S -- (Nai"ne o~ indivlduol si§ning controcf) being duly sworn, deposes and says that he ~s the apphca~ above named. He ~s the ............... ~ ...................................................................................................................... (Contractor, agent, corporate officer, otc ) of sa~d owner or owners, and ~s duly authorized to aerform or have performed the sa~d work and to make and fi th~s applicahon, that ell statements contained m this apphcahon are true to the best of his knowledge and belief; a~ that the work will be performed m the manner set forth m the apphcation filed therewith. Sw°rnc~/~/ef°re me this,7c~ .~.///~/~. ........... ,,., ....... day of ..................... , 19---- Nota~ Public, .,~. ......-- --~.~.C~0~ ~ ....... Coun~ M~ E. DAWSON N~ARY P~LIC, State d New Yor~ Term ~p~res Mgzch ~, · (Signature of applicant)