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Home My WebLink About10074-z l~Ol~1 NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N.. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) N? 10074 Z Permission is hereby granted to: /, .. ~_/...~.., .......... et~re~ises'aea~e~ot ....... ~ ...... ~...~.K~.....~..~ ........................................................ ........................... ........ : ..... Building Inspector, FO]gM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. NOTICE OF DISAPPROVAL File No ................................................................. Date ..... ~~~,,....~,.. ....... , 19/.~.. / X ..~...........~.......7.~-./. .............................. ..~~~..r.~l..:~. ......... ~/.~.~ PLE~ ~E NOTICE that/your appJication dated .-~....X~: ................... ..~~.~ ............ ~,,~,, ~l~.~..~.~,,o., ....... :.~ ...................... ~o, 'm ,- Building Inspector I~OKM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE .~-, SOUTHOLD, N. Y. ........... . . .......... ~o~,~ ~...~.~.....z~ ......... , ,,~ ~.~, ~o. ./.~.~...:~ ..... ,,, ........................... ................................ APPLICATION FOR BUILDING PERMIT Date ................. ~...2~.. .................. , 19...7.., _~.,. 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. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout ofproperty must be drawn 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 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 th6 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 applicable taws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and ir~ buildings for necessary inspections. ............................. ~x~;;;;;.~..;~.~.;~.;.;~.~ .......................... State whether applicant is owner, lessee, ~q~nt, architect, engineer, general contractor, electrician, plumber or builder. ............................................. '~,.,!~.~.~ .......................... :: ........................................................................... Nome of owner of premises ....................... ~ --~,~Z~ ....... ~..~ .................................................................... If app~nt~is a corporate, signature of ~uly authorized officer. ~~~f .... Builders Lic~se No ........ ~.~ ........ ~~ Plumber's License No ................................................. Electrician's License No ............................................. Other Trode's License No ............................................... Location of land on which proposed work will be 4one.--~_ ,-/-~ Map No.: .~...~.~ot No,~ --,~---~ ~ ......................... Street and Number ................./.~F~..~...~L,./¢:?¢~ ......{~..~ .............................................................. Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ................... ..~..~..,.C~...'..~...~/..~..........~......~....~...~.. ...................................................... b. Intended use and occupancy ........................................ '. ............................ 3. Nature of work (check which applicable): New Building. ................. Addition .................. Al~.~otion ~:: .......... Repair .................. Removal .................. Demolition..' .................. Other Work ............'~.... ~/...((...(~:..~--~. ,. ............ 4. Estimated Cost ....... ./....7....~...~. ...................................... Fee .......................................................................................... (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 ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ Nome.~ Former Owner,~..~fb.t~ ............................................ 11. Zone or use district in which premises are situated ............ ~~....../~......' · ............................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded . ........................... Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises .~2~/..~..~ ............... Address~ ........ Phon~ No. ~..~,.~-..7.~.?....~.. Name of Architect .............................................................. Address ................................ Phon~ No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate oil set-back dimensions from prop~:rty lines. Give street and block number ar description according to deed, and show street names and indicate whether interior or corner lot. V STATE OF NEW YORK, ~.(~ ...... .~..:..~.~...:_.~.*..':...;7. ........................................... being duly sworn, deposes and soys thor he is the applicon~ ! (Nome of individuol signin§ controcf) above named. O~¢_/__,,,~ He is the ...................... ~..., ..................... ~.:..~.~.r..:...r ...................................................................................................... (Contractor, agent, corporate officer, etc.) of said 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 tk, a~ the work will be performed in the manner set fo~h in the application filed therewith. Sworn to before me this ........ ........ ......................... Notar Public~ . Coun~ .~ .... ~..;...l~;~ ~ARY ~l. fS. ~tate of No. 52-8125850, S0/folk