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Home My WebLink About9896-zTOWN OF SOUTHOLD EUILDING 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) No. 9896 Z Permission is hereby granted to: ~ ~vrem.ses located at ................ ................................. .~.. ....................................... ~ ......... .......... ~.., ................ .~ ,~Z'q. ~'~"' a ~/.. . . . , ' pursuant to application doted . /~ 0 ~'~ /~, 9....:., on4 oppro¥~d bYOb~ ' Building Inspector. ............ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. proved ({ ......... : ........... ........................................ , 19 ........ Permit No. (0 ~ Disapproved a/c .................. ~................................... ................ ................................................................................. ............. .......................... ......................... ........... (Building Inspector) Application No...~....,.~, .~ ................. APPLICATION FOR BUILDING PERMIT Date ........................ ~...~'...~......./...(...,., I~.......~....., INSTRUCTIONS o. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Building Inspector, with 3 sets of pluns, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of tot and of buildings on premises, relationship to adjoining premises or public streets m areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is port 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 the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of o 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 aJterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable lows, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. of opplic;nt,~- norr~ if o corporat, ion) (Address of applicant) [ I ~. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .............. .~,..~. ..W..~.....I~..Iv (~' j~ ~- E ~ ~' H ~ ..~,.. ,~ ~, . 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 ............................................. Other Trade's License No ............................................... Location of land on which proposed work will be done. Map No.: ........................................ Lot No ......................... Street and Number Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisifing use and occupancy b. Intended use and occupancy 3. Nature of work (check which applicable): New Building. ................. Addition ................. ..~Alteration ................ Repui. I~emoval Dernolitior ..... Other Work ............. ~-.'Y..~. ............................... ................................... ~ (Description) 4. EstimuJed (] os[ ............................................................ Fee (to be paid on filing this application) '5. Ii dwelling~ nuinbe: of dwelhng units ............................ Numbor of dwelling units on each floor ..... , ...................... I+ garage, number of c<lrs ............................................................................................................................................. 6. If hu~ir:css, commorciu] or mixed eccuponcy, spec:fy nature crud exterd of each type of use ............................ 7. [)imenslons of existing struck'utes, i[ any: Fror,t ............................ Rear ................................Deptl~ .................... I-Iolght ...................... Number oF Stories ................................................................................................................. Dh'r:ensions of same structure with allerations or additions: Front .................................... Rear ........................... Del)d: ................................ Height ...........................Number of Stories ................................ 8 Dimeoslon:, of erfllre new construction: Front .................................... Rear ............................ Depth ......................... J leifiJd .................... Number o¢ Stories ..................................................................................................................... 12. Poe~ propn~ed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot bo ,egroded ............................ Will excess fill be removed from premises: ( ) Yes ( ) No 14 Nc:me at Ov/n~J ut pte:nJSeS ~ ~O~ ~ Address Phone No. ~ ~ Narno uf A~chite, I ........................................................ Address ................................ Phone No ....................... h,,m:u ~ ('ontr~ch~r . ........................................................ Address .......................... , ..... Phone No ....................... PLOT DIAGRAM I.occde clea6y arm cilsti~cify all buildings, whether existing or p~oposed, and indicate all set-b~ck dimensions from tin, petty lines. Olive sh'eet und block number or description according to deed, and show street narnes and indicate ~ , /, ~1'~~- (iq,u,:,- of indlvMuul signing contractO :lc ~s ,:o .................... 0.~'..~.~ ...................................................................................................................................... ~ctor, agent, carpomte officer, etc,) o[ sold uw~or or ~woe~:, cu~d u, duly au~horiTed to perform or hav~ performed the sold work and to meke and file ~115, ,. ppli, ,~ll. ~}, ill(l[ ('~l Bti~l'(]~?lents contoined in Ih:s applier:lion are true to [he best of his knowledge and belief; end lhe WOII~ >¢ih lie l:C k)m Jcl m the rnonner set forbh in the application filer] therewith. ........ : ...... c . ................................ ~ ~ ~ ~ ~M~ ~ ~ ...................................................................................... ::..: ........................ ~ -- ~ ~O~y PUBLIC, St~o of New York