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Home My WebLink About9328-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 9328 Z Pelrmission is hereby granted to: ............................................. at premises located at ......................... ,; ..................... ; ~?~,, pumuant to opphcot~on dat~ .............................................................. , and opprov~ by the B~ilding Inspe7 , FO~M' NO, 1 TOWH OF SOUTHOLD BUILDING DEPARTMEHT TOWN CLERK'S OFFICE iii/'~-~ iil...~.~.'iil.'~.'.'i:~i SOUTHOLD, N. Y. Examined 19..?...Z IApplicotion No..~....~......~...~ ......... Approved1~.?.?.o Permit No ..... 2,.~......~/0....'~....~ .... ............................................... ........................ APPLIGATIOH FOR BUILDIHG PERMIT Date .................. , INSTRUCTIONS a. This application must be completely filled in by typewrtter oe in ink and submitted in triplicate to the Buildir 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 odjoming 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 ~ssuance~of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the apphcant Such perm 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 Occupan, shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance bfa Building Permit pursuant to Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regular'ohs, for the construct on of build'ngs, additions or alterat'ons, or for removSI or demolition, as herein describe. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in buildings for necessary inspections.. (Signature of appl~ant, or/name, if a corporation) .... ...... .................. (Ad'tress of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contra6tor, electrician, plumber or buHde Name of owner of premises ......... ~.~ C~,. ~.' ...~.~ f"l ....... ................................................................................... If applicant is a corporate, signature o du y authorized officer. (Name and title of corporate officer) Builder's bicense No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Zrade's License No ............................................... ~ ~ /) 1. Location of land on which proposed work will be done. Map No.' ................. ~ ................. Lot No../.. .................. Street and Number ..... .~...~...~....'~.~.....~/.~.~...~J. ............... .~X~....~/~n.~...~-~..i ...... .~.~.~... ....... [ Municipahty 2. State existing use and occupancy of premises and intended use and occupan,by of proposed construction: o Exisiting use end occupancy ............ ~. ........................ ! ....................................................... 3 Nature of work (check which apphcable) New Budding ............ Add~¢ion .................. Alteration ............. Repair ................Removal .................. Demolmor ................. Other Worl;, ....... ~..~ ............................ 4 Estimated Cost ...... ..~J..,~...O.. .................................... Fee ................... ?..Z..~.Z ........................... i.D..~.r,ipt'°n) (to be pa~d on filing thts apphcation) . 5 If dwelling, number of dweli,ng units.,, ......."~ ............... Number of dwell,ng un,ts on each floor--~..~' ,~... If garage, number of cars .......... ~/~. ....................... 6. If business, commercial or m~xed occupancy, specdy nature and extent of each type of use ......................... 7 Dlmens,onsof exist,rig structures, ~f any Front1~?~....'' ' ~ .......... Rear ..~.O..i ............ Depth ...?. ~..,~. Height .~,,.~.! ............. Number of Storms ..... ~ ...................................................................................... D~mens~ons of same structure w~th olterabons or addmons Front . .~ ................. Rear .............. Depth ............................ Height ............... Number of Stories ........................... 8 D~mens~ons of entire new construction Front ..... ~ ............... Rear ......................... Depth ............. Height ............... Number of Stories ..... ~. .......................................................................... 9 S~ze of lot Front ..... ~.~'..~ ..................................... Rear ..... ~5-~' ................ ,. ............ Depth ....~..~.. ................... 10. Date of Purchase ............................................... Name of Former Owner ..................................................... 1 1. Zone or use d~stnct m which premises are s~tuated ...... ~..../ ............................................................. 12 Does proposed construction wolate any zomng low, ordmanc'e or regulatio,n ......... ~1~.. .................................... 13 Wdl lot be regraded ..... ~ ........... Wdl excess fdl be removed from premises: ( )~ Yes ( t~No Name of Owner of premises ..... ~/L~;../~: .T..~~ .......... Address .~,~.~...~."/,..: ............ Phone No...~...?.:,.~.?..~'..~ 14:_~ , Name of Architect ...................................... Address ................................ Phone No ..................... Nome of Contractor ............................. Address ................................ Phone No ..................... PLOT DIAGRAM Locate clearly and d~stmcdy all buddings, whether ex~sting or proposed, and re&cate all set-back d~mensions fra~ property lines Gwe street and block number or description according to deed, and show street names and indicat whether interior or corner lot 5 ST^T OF Y m<. COUNTY OF ..... .~.'~..~f~ .~..1~. ....... f~ ~ ~s~s ~'~d s'~ys that he is the apph~c, .................. /.~-,: ............................. (Skrnature of applicant) Sworn to before me this ...... .~..~..¢.]: ........ day of ......... Notary Public, . ........................ ,~1.1~'~J.~ ....... County ELIZABETH ANN NBVILL~ NOTARY PUBLIC, State of New York ., Suffolk ...................... :..~.,..4'~::~"g...~Olll~eO~ .................... being c~uly sworn, 'dep (Name of md~wdual s~gn~ng contracf) abow nozned He ~s the ........................ ~.cJ.~i~.~...;[¢l~. OT~,~,l~ .................................................. : ..................................... (Contractor, agent, corporote officer, etc ) of sa~d owner or owners, and ~s duly authorized to oerform or have performed 'he -smd 'work and to make and this application, that oil statements contained ~n th~s opphcahon are true to the best of his knowledge and behef; · that the work wdl be performed m the manner set forth m the apphcahon filed therewith