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Home My WebLink About9176-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 9176 Z Dote ................................. pr, il ........ 8...., 19.'.;.~.. Permission is hereby granted to: ~ ~ ~ ~ ~ ~ .~0 ,'~..C ~ ~ Zi,~e,hka .............. ~b~;,~.~:~,;~.~..Ave ......... -Ri~e~h~d- to ..~:~f~..~..~u~-~,-.* ~ .,,~ ~.~,~-.. ~.~ ~-~'--a~'. pe~..~p~'~c~o~ '-~'"~0 .... at premises located at .~..~.~9~Jr"~V~"~ ...... ....................................................... ~,~;~;.~..t~ ....... ~(.,.~., ................................................................ ~'~ g 19..~,~.., ~nd ~pproved by the pursuant ~o application d~ted ....................... ,~:......aO ................ , Building Inspector. Fee ~.~.,.~, ,-~ ............. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. , pro ed ¥ {~uildin~ In~p~tor) Application No. ~/ ''~ ~ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter o¢ 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. Plot plan showing location of lot and of buildings on premises relationsh p to adjo n ng premises or public streets az areas, and giving a data led descr pt on of oyout ofproperty must be ~lrawn on the 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 Building Inspector will issue o 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 o Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment 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 applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and ir~ buildings for n,~ry inTctions. / (Signature of appli?xnt, jOrJnome, if a corporotl;~¥ ........ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......................................................2'a e f n ' ~ ............................................................. A~i~.,/ /.~r -/~X: ~.. ~~7'~', ............................/'~_5 dC( ~/ ~./?~: ..................................... ,-~ m o ow er aT premises ................,...¢..: ......................................... :-. ...... ~:,.. .............. ~.,...~. ~. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............... u ............................ Other Trade's License No.il~.l~.~.~t/?~...~.......~...~ .... Location of land on which pj'oposed woj~ will be.done. Mop No.: ........................... .~._. .......... Lot No.....c.:..~...._~.. ......... Street and Number ..... ..~..~..~'..C.~..~.....~?.'.~.%~..C.~:~..~..~¢~.t~.(~.......~'~'...-f~,¢...:....~.~.; Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ' b. Intended use and occupancy ................... (/"m~'*/'"'""~'"*"c~'"~ ........................................................................ 3. Nature of work (check which applicable): New Building,. ................. Addition..i./.;-..-.,--... Alteration Repair .................. Removal .................. Demo ition . Other Wor~ww~,~,c,,r.~~... .... ~' ~,~,,J ~ (Descripti°n)~'~(~ 4. Estimated Cost ....... ...~.. ................................... Fee .. ~...I,~...'~..~ ................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Numbcr of dwelling units on each floor ............................ If garage, number of cars ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent o~ 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 ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ................... , ................ Rear ............................ Depth ........................ I-Jeight .................... Number of Stories ...................................................................................................................... Size of lot: Front ..g~ ......... ./.'...~.....~..../. ..... Rear ................ ./...~....-~.......~ ......... Depth ................................ Date of Purchase ..... ~2........~. .................................... Name of Former Owner ..~.~.~...~..~.~f~..~... Zone or use district in which premises are situated ..................................................................................................... Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ Wil~ lot be regraded ........... .~") .......... Will e~xcess fill b~, removed,~,om pr~mise~;~ ( ) Yes ( ) No Owner ' ~ 6'~ ' , ................. ,~ , , ....................... ,~'~ of of prem.ses~ ........ .~.~...' .~:. Address 4~...~,~...... Phone No ~,~ F~ame Name of Architect .............................................................. Address ................................ Phone No ....................... Nome of Contractor j~i.l.~.l~.~.~ .~...~.......~.~ .~..~l~,..~..e,.... Address¢~.J.~..~.~/~rlC./~.(~.~Phone No.7..~..7...-c..~.~.~..~1 10. 11. 12. PLOT DIAGRAM Locate clearly and distinctly ail buildings, whether existing or proposed, 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 whether interior or corner lot. / STA~-E OF NEW ~f'OR,~,.,9 ,//~c c .T¥ OF ..4"'" , ....... ~.~~.~.~....~.~..~~ ............... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ...................... .~..~..~ ............................................................................................................................. (Contractor, agent, corporate officer, etc.) of s~id owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and thaTsworntheto workbeforeWillmebethisPerformed4 in,the4 manner, set fo~h in the application~~ filed therewith.~~.~~ · .~Z ............. day of ...... ~.~ ................ , 19..~. ' Z'. .... ..... (Signotur~ appJicanf) ff~ 52-~08300 ~ ~bS~ ~p~ M~ch 3~ !~