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Home My WebLink About9136-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) N? 9136 Z Permission is hereby granted to: ~.o...~...m ~..~$~.~...~..~. ~.~. ....... .O~.~.~.s ...... ..................... B~y~e~'e...l~d. ...... ~ree~poz't to ..B~.:I:.~ ~l... a~. · ~ &~. $,.~ ~,~ .. ~>z~... ex~.. s ~.~ zt.g ·. dwe ~.]: [~ ~ ............................................................... at premises located at ...~..~ ....................... ~.eao~c...Bay..E,~t,.....Amm~lld~l ........................ ............................................ ]~a~.~h~..Ro~ ........ .O~'~e~p~,~ ..................................................... pursuant to application dated .................. .~.~......~. .................... , 19....~, and approved by the Building Inspector. Fee $...'1.5~,D:0 .......... ildi In FOI~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ............... t..~ .......... c...r. ....... , 19 ...... ~emi~ No. Disopproved o/c~ ............... ................................ ................................. Application No .............................. APPLICATION FOR BUILDING PERMIT ......... , ....... : .......... ............. , ..... Date 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. Pict plan showing location of lot and of buildings on premises, relationship to adjoining premises or pubhc streets or areas, and giving a detailed description of layout of property must be drawn on 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 Budding Inspector will issue a Building Permit to the applicant. Such permit 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 Occupancy 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 the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all apphcable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........................................................ ................................. Name of owner of premises ............................................................... :~¢,~.,.,~ ..................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: .................... Lot No .............................................. Street and Number .......... .~?..~'.~.~,...,~,~.~.'/.~.~Z'.~,~.~,.....-~.J~.., ............................ .'~4:;;'~'x~.-,z~-~'~',~,, ......................... -- ,~unicipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Ex~st~ng use and occupancy ............ ~. ...... .....~:~z.~.~ .................... ~ .............................................................. Nature of work (check which applicable): New Building ....................... Addition ...... .~.... ......... Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... (Description) 4. Estimated Cost ............ ..~..Z ...O.. ?.,.O....~ ...... Fee ......!.~.,L.,~ ........................................................................ (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 ..................................... 7. Dimensions of existing structures, if any: Front ....... ~ ....... Rear .........~...~.- .............. Depth Height ........................................................... Number of Stories ............... ./.. ........................................................... Dimensions of same structure with alterations or additions: Front ........ ..':~.~./...~. ....... Rear ...........~'M'"; ....... ~ ........... Depth ............... .~,.....? .................... Height ......................................... Number of Stories ............ ..~ ....................... 8. Dimensions of e'~l~ee'~'' new construction: Front ..................... ~... Rear ......._... ...... ..~. ....... Depth ........ ~.,Z,...~..z ........... Height ................................................. Number of 5tor,es .............. ~, ....................................................................... 9. Size of lot: Front .................... ............ Rear ..................... + ................... Depth ........... .,~,~,~,,..t. ......................... eof Height .................................................... Numb r Stor ...................................................................................... 10. Date of Purchase ..................................... Name of Former Owner ............................................................................ 1 1. Zone or use district in which premises are situated ........ ,~,~...; .................................................................................... 1~. Does proposed construction violate any zoning law, or,fiance or regulation: ......... ~/~ .......................................... 13, Will lot be regraded ......... 'v ......................... Will excess fill be removed from premises: [ ] Yes [ ~zNo 14. Name of Owner of premi~ ............... ~ ...................... ~ ......... ~ ........... ~ ..................................................................... Name of Archite~t .................................. ~ ....... Z .................................................................................................... ~.Z.L~-' ~' ~ ~ (Address) (Phone No.) Name of Contractor ........ ~ .... ~ ..................... ..,.~ ................. ~ ....... ~ .......................................... Locate clearly and distinctly all buildings, whether existing or proposal, 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 wheth- er interior or corner lot. STATE OF NEW YORK, ) COUNTY OF ......... ,~11~:~].1~ ..........' ............... ) ................................ ~]Jkl~O~...~l'~,~.~.], ......................................... being duly sworn, deposes and says that he is the applicant above named. (Nome o£ i~di~id~al si~ning ~e is the .............................................................. ~. ..................................................................................................................................... {Contractor, agent, corporate officer, etc.) of said owner or owners, and is dulv authorized to perform or have ~orformod the said work and to make and file this a~Olication; that all statements contained in this aDpHcation are true to tho best of his knowledge and belief; and that the work will bo Dorformod in tho mannoF set forth in tho a~plicat~on filed therewith. ............... ~ ........... day of .......... ~.~ ................... 19 Notaw Pubhc ............................... ,""~ "[~ ...... "~0"~' ~' '""3~"1, '"'N'"'"~(: .............. -z'"'"C't': ..........................................