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Home My WebLink About9360-z FO'n.M' NO. 2 TOWN OF $OUTHOLD 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) 9360 Z TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWH CLERK'S OFFICE SOUTHOLD, N. Y. Examined ............. ....~.....~... [..~-, 1977 Application ............................................................... ......... ...... ........ ..... (Building Inspector) APPLICATION FOR BUILDING PERMIT / ]077 Date INSTRUCTIONS a. This application must be completely filled in 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 buddings on prem:ses, relationship to adjoining 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 Bu.ldmg Permit. d Upon approval of this application, the Building Inspector will issue a Buildmg Permit to the applicant. Such pern shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied ar 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 of a Building Permit pursuant to ti Building 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 removal 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. / (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build: Name of owner of premises ...................O....l~...~.¥J.~ .................................................................................................. If apphcant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ....................... .~.~..~.../J'~....!..~.~//. ...... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Map No'. ..... .~...~.~..~..~... ......... Lot No ......~...Z ........ Street and Number ..... ..~....~....~..,.~.. ........ .~/..~1~7'..~.....~..~,. ...... ,.'~.~?.....?...~....~.~.?. LC,.~., ....... ..-~-..~..~....~.~..~,.~..'~.. Municipality State existing use and occupancy of premises and mtended use and occupan:y of proposed construction: a Exisiting use and occupancy .........................l.....~..~..~.?...(....~....~.. ............... ..~....~./. ........................................... b Intended use and occupancy .......... ..~...~.,./~...,/::.i ............. ...~../:..-'~.,...,J~.. ............... ~..q~..'f,.~...~ ........................... 3 Nature of work (check which applicable) New Budding .................. Addmon .................Alteration Repa, r ............. Removal~ ............... Demoht,or .............. Other Work ........ f/?.~...b:'../.c~.?-(.~. .................. (Description) 4 Estimated Cost .................... L.O...'Z'.. .......................... Fee .......f.,~... ...................................................................... (to be pa~d on f, ling this application) 5 If dwelling, number of dwelhng umts ........... (. .......... Number of dwelhng units on each floor ........................ If garage, number of cars .............................................................................................................................. 6. If bus~ness, commercial or m~xed occupancy, specify nature and extent of each type of use ........................... 7 D~mens~ons of exmtmg structures, if any' Front ...................... Rear ................................ Depth .................... Height ....................... Number of Storms ......................................................................................................... D~mensions of same structure with alterations or addmons Front .................................... Rear .................... Depth ........................... Height ................... Number of Stones .............................. 8 D~mens~ons of entire new construction Front ..................................Rear ..... ~ ...................... Depth ................ Height ................. Number of Stories ......................................................... 9 S,ze of lot Front ...................... ./..~'.....'~... ............. t~;~; ~ ~:~' ~'1~ '~ Z"'Z"~'Zi.~.' 10 Date of Purchase ................................................. Name of Former Owner ...................................................... 11 Zone or use d~str,ct ,n wh,ch prem,ses are situated ............ .~. ~/....-~... .................................................... 12 Does proposed construction violate any zoning law, ordinance or regulation: ...................................................... 13 WHI lot be regraded ............................ WHI excess fill be removed from premises: ( ) Yes (/'~'~'No 14. Name of Owner of premises ....... ~..~. ...... ..~....~....~..~..C.~.~. ......... Address ................................ Phone No/?..~..~..../...~...~..2. Name of Architect .................................... Address ................................ Phone No ..................... Nome of Contractor ................................... Address ................................ Phone No ..................... PLOT DIAGRAM Locate clearly and dmt~nctly oil buildings, whether ex~stmg or proposed, and red,cate oil set-back dimensions fro~ property hnes Gwe street and block number or description according to deed, and show street names and in&cai whether interior or corner lot /o o- 79'- 2. S-FATE OF NEW YORK, tc COUNTY OF ........................... above named. '"(Contractor, agent, corporate officer, etc ) of said owner or owners, and ~s duly authorized to perform or have performed the said work and to make and f this applicahon, that all statements contained in this application are true to the best of his knowledge and belief; a, thor the work will be performed ~n the manner set forth m the apphcation filed therewith. Sworn to before me this - / /-*'/MARY E' DAwsoN tIOTAR~ PUBLIC, State o~ New York No. 52-4643721, Suffolk Coua~y~ Term Expires March 30. 19 ~'