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Home My WebLink About9351-zTOWN bF SQUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFIGE SOUTHOLD, N. Y, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 9351 Z Permission is hereby gr(3nted to: Approved FORUM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT . TOWN CLERK'S OFFICE ~OUTHOLD, N. Y. 197.,~.... Permit No.~..~..~..~ ............. Disapproved a/c ..~....._.....~ ....................... (Bm drag nspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and sdbmitted in triplicate to the Buildi, Inspectqr, with 3 sets of pkms, accurate plot plan to scale. Fee according to schedulb. b. Plot plan showing.location of lot and of buildings on pr~m,ses, relationship to ~djoining premmes or public streets, areas, and giving a detailed description of layout ofproperty must be drawn on the diagram wh,ch ,s part of this applicatio, c. The work covered by this application may not be commenced before issuoncelof Budding Permit d. Upon approval of this application, the Building Inspector will issue a BraidingI 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 what.~ver until a Certificate of Occupant shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance ~)f o Building Permit pursuant to t~ Braiding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances, Regulations, for the construction of buildings, additions or alterations, or for remow or demolition, as herein describe, The apphcant agrees to comply with all applicable laws, ordinances, building code, ,ousing code, and regulations, and ~ admit authorized inspectors art premises and ir~ buildings for necessary inspections. (Signature of appl: cant, or name, if a corporation) State whether applicant ~s owner, lessee, agent, architect, engineer, general contradtor, electrician, plumber or buHde .............................. c.Qn.~.~ ~i Old. ....................................................................................................................................... Name of owner of premises .~d~l,~,...~....o..o..~..~....~.?.., .................................................................................................. If opphcant is a corporate, signature of duly authorized officer. ......... · .~ .... PS. ri 0.~ r~e ............................................... (Name and title of corporate officer) Builder's License No ........... ..~..L.~...~.!.-..! ........................ Plumber's License No ................................................. Electrician's License No ............................................ Other Trode's License No ............................................... ~)~ Lot No ~ Location of land on which proposed work will be done. Map No .................. I ....................................... Street and Number ..~c~0..Jff~.b~u~sO...~.~,.~..~D~l~O. ld.~..~..~.o...~l, cJ.~ ................................................. Municipality State emsting use and occupancy of premmes and in;ended use and occupancy of proposed construction: a Exisiting use and occupancy .... D~ft..-J2~l~'...flhr.~.l,,~rl.g ................ ! ................ . .;,~, ................................ b Intended use and occupancy .... DZl~t..-f'allll] Ir..(1.t,~.'13,5.:1~ ............................................................ ~ ...~../~.~'.~..y ~~ ~ 3. Nature of work (check which applicable)' New Building ................ Addition ................. Alteration ............ Repair ................Removal .................. Demolmor. .............. Other Worl~ ..-~-encJ~. .............................. ~ (Description) 5 If dwelling, number of dwelhng units ......................... Number of dwelling units on each floor .......................... If garage, number of cars .......................................................................... J ....................................................... 6. If business, 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 ................................................... ~ ....................................................... D=mensions of same structure with alterahons or addmons Front ................. J .................. Rear ....................... Depth .............................. Height ...................... Number of Stones ........ ! ....................... 8. D~mensions of entire new construction: Front ................................... Rear ............................ Depth ................... Height ............... Number of Stories ................................................... ; ...................................................... 9 Size of lot. Front ....... ~..t ............................. Rear ........ ~.3.Q! ........................ Depth ..... ~3.Q.~. ................. 10. Date of Purchase .................................................... Name of Former Ownerl ...................................................... 11. Zone or use d~str,ct m which premises are s~tuated .......................................... ; ..................................................... 12 Does proposed construction wolate any zoning law, ordinance or regulation' . ...................................................... 13 Wdl lot be regraded ...................... Wdl excess fill be removed from premises: ( ) Yes ( ) No 290 Wabas~o St. Name of Arch,tect Address ' Phone No. Name of Contractor ................................... Address ............... I ................ Phone No ...................... PLOT DIAGRAM Locate clearly and d,stmctly all bu,ld,ngs, whether ex,sting or proposed, and ,fld~cate oil set-back dimensions fror property hnes. G,ve street and block number .or descr,pt,on accord,ng to de~.d, j ~d show street names and ind~cat whether interior or corner lot - ~.z~ . ?~ .~ ? ~ STATE OF NEW YORK. COUNTY OF .~u~.folk .............. f.~, j .................... S..,. E.~.~?iG.0~ ..................................... being duly sworn, deposes and says that he ,s the opphca. (Name of indiv,dual si'gnmg cont'rac~) ~. above named He is the ................... OQ~.*.8,f~$.Q*. ....................................................................................................... (Contractor, agent, corporate off,car, otc ) of sa,d owner or owners, and Is duly authorized to oerform or have l~erformed the said work and to make and fl th,s applicahon; that all staterr, ents contained in this apphcohon are true to the thor the work will be performed in the manner set forth ,n the appl!catj, on/~iled the.r Sworn to before ~n~ th~s ..... ~ ....... d o ............. ..... ............. ~ /-~ ' '~ '~ //(Sigr NOTARY PUBLIC, State of New No 52 8]25850, Suffolk Count~_ )est of his knowledge and belief; ature of applic.nt)