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Home My WebLink About9970-z FOI~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. No. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES uNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: · .~,~.~.: ...... ~Z.~ ..u..L<...'Z?~,~. ~ ...... ............................................................. ............ ~.~ ....... ~ .......................... ~ ........................... .............. ,, .......... ~..,,.~.~ .................. , ....... ~t premises l~o~ed ................................................ .... ....... , ...... f, ....... ~ ...... , ............. ..... ~"'""~'"'"~ .................... ~'r"' .............. c ................ :: .~..?~c?..;.-.;~.,~;~ ,.~..~....~;...: ......... t ............ ; ............ pumuo~t to Oppl~cohon ~oted, ........... , ............. ~ ,-..~ .......... ,~ ~,- 19 , , ond o roved b ~he . PP Y Examined ...................... ~ ................ , 19 ........ ,'7' ,/ Z Approved ........................................ , 19..' ...... Permit No ........................................ ~ ...... ~ Disapproved a/c ................... {ZZ~].:~:.t, ....... [.. ,. ]]Z~.~Z~L::~:,::,: ................... ~~~~ ................................................................................................ ~' d~ (Building Inspector) TOWN OF SOUTHOLD /~/ ~L, ,..~ :~,,~ ~/~..~4.~_ -,, BUILDING DE~RTMENT/~// /t~ TOWN CLERIC S OFFICE ~pli~a~i~ ~ ................................. APPLICATION FOR BUILDING PERMIT 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 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 areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this applicatiorC c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Mspector wilt 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 aJterations, 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 in buildings for rjs~;~ary inspections. ' (Si~'~atbre aT apj~a~:'~ame, if a corporatio~ ....... d lA, dress or appucant) State whether applicant is owner, lessee, agent, architect, engineer, g~en'~ral contra~;') electrician, plumber or builder. Name of owner of premises ......... .~.. ..........¢~.~. ...... t~... .............................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .............m~,.,...../. .......................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... .~ 1. Location of land on which propose ark will be ~l~n~. Ma~qo~: ..... ~ ¢"/ d: ........................... Lot No.....~...t1~,...;¢:~ .... Street and Number ......... LL,,~.~,,..~..,~,..~.....I.'.'.~.[, ....... .].~-~-' ........................................................ .t....~......g.... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ................. ~,~..~J?,...~3..~. ......................... : .................................................... b. intended use and occupancy ................................................................... ;,,, . ...~ .......................................... 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ............... Repair .............. .~... Removal .................. Demolition .................... Other Work ................................................ .... ~ (Description) 4. Estimated Cost ............. ..~.....(~.. ...... 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 busines~~ 'co~'nme'rciol dr mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensiofis of existirig structures, if any: Front ..... t~...~1~ ........... Rear .t.~.i~...~ .................. Depth . ..~.....~.. ..... Height ::....:~.~....'.,..:... Number of Stories ................... j .............................. r'~'"vr ............................. ',.-"*..~-.*v ........ Dimensions of same structure with e tarot OhS or additions: Front ..... ~,..~.,...,1~. .................. Rear ...... .¥. ................... Depth ......... ~.~ .............. Height .....tl....~l.,, ............... Num?er of Stories .............. ; ...... ,., ........ 8. Dimensions of entire new construction: Front ...... .~.~:..6.,.: .............. Rear .....~..~....~. ........... Depth .....f. 9 ............. Height .....t~...~'. ....... Number of Stories ............... 1. ..................................................................................................... ¢ - ....... ........... 9. Size of lot: Front ...............'t"~"~ ............................. Rear ............... .?..,~ ................... Depth 10. Dote of Purchase ........................................................ Name of Former Owner ........................................................ 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 .~,~.~.~,.~I~ ................... Addres~.~..&,~.~. ~,~.~..¥.~. Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No.,.~,~, ~ "'"~'"~'"~'~ ..... Name of Contractor ............................................................ Address ................................ Phone N.o~.~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate oil set-bock dimensions from property lines. Give street and block whether interior or corner lot. number or description according to deed, end show street names and indicate ,,, [ STATE OF , ~ S.S COUNTY OF ................................. above named. ' ' ~ ~'~' ~ ~p,~ ~e ng du y ............ "5 ' sworn, deposes and says that he is the applicant He is the ............................................... ~,~... ................................. .~...~..-.;~ ................................................................... ~ontrac~o~, agent, corporate of ic r, c.) of said owner or owners and is duly'~o p,'rform or hove performed the said work and to make and file this appiication; that ail statements contained in this application are true to the best of his knowledge and belief; and that ~e. wg~ will be performe~ iqthe mann, set fo~h ~;the applic~ed therewith. ....................... ,, ........ /¢' I~OfO~ Y~DIIC¢ ............................................. ~ ..... ~uql IW ................................ : ...... ~....~.,--~ ................. l ......... jUDITH T. TE~ (S~gna~ applicant) Nota~ Public, Sts(e of New No. 52-0344983 Sqf[olk Coun~ Commissio~ ~pires March ~0, /