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Home My WebLink About9706-zTOWN OF SOUTHOLD BUILDIHG 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) N? §706 Z Date .....~[&y ......... ~ ............................... , 19...~8. Permission is hereby granted to: ............. E,~wa.~,d...W'.o...C&ven~.,... ,Lesa. ee ........... ...~Z.~....A..,...~.~s.~.o.~..e. ........................................... erect a fence at premises located at ............ 6lS.....~.tke.,St~.ee.~ ......................................................................... ................................................ Ma,t;-'b.i-tuek.~...Ne~..Yez, k. .................................................................. pursuant to application doted ..... ~.~,'J,]l, ....... 2.'J .......................... , 19....78, and approved by the Building Inspector. Fee $..1.~ o~0 ........... ...../...:'...../..~..~ ...... Building Inspector Examined ..... ~a:v. b, 19...7..~. IrOBM NO. ! TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No ....... ~.~..0.~ ................. Approved ,..:.,..~,.~.. /~ 19.78 9706Z,. ............... , * · Permit No. Disapproved a/c ....... ................ ~ ............................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ....... Z ...................... , INSTRUCTIONS J a, Th s app ication must be completel fille f by typewriter or, n ink and submitted in triplicate to the Building r~sp, : Y d 'n · actor, wfth 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 dotal[led descr'ption 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 Bui ding Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the prerhises 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 NEREBY 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 laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and ir~ buildings for necessary inspections. (Signature of applicant, or name, i~"~"~'~'i~l~'o';~'~i~l~'~ ....... ~' I '"~'- /~'''t'l~ ~ ..5; (,~dress of applicant) ;tote whether applicant is owner,C, es~, agent, architect, engineer, general contractor, electrician, plumber or builder. qame of owner of premises ...... .(~..,.. !?,../.~..~ '/.~'-'0 ~ ~ ? f applicant is a corporate, signature of duly authorized officer. (Nome and title of corporate officer) " Builder's License No. (~ xxL,% . Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................. t. Location of land on which proposed work will be done. Map No.: ............................ Lot No ......................... Street and Number ......................... ......................................................................... Municipality 2. State existing use and occupancy of premises end intended use and occupancy of proposed construction: a. Exisiting use and occupancy /~'O b. Intended use and occupancy 3. Nature of work (check which applicable): New Building,. ................. Addition .................. Alteration ................ Repair Removal Demolition .................... Other Work .~,-~..~./? C .,~, .... '~'O ~.' ~ ~/ < (Description) 4. Estimated Cost ............................................................ tee .......................................................................................... (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 ........................................................ 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: ........................................................ I3. Will lot be regraded . ........ ,~/~....~.. .......... Will excess fill be removed from premises: ( ) Yes ~) No 14. Narne of Owner of premises .,../~...: ......P../.~.~..7.?....~...~. ............. Address .;.: ....... ; .................... Phone N(x ...................... Name of Architect .............................................................. Address ................................ Phone No ....................... Nome of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all 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. COUNTY ............... ~,'.~'d~..~.~.C~....(.,~.... ........ L.~'..t,¢C,-~.....~.. ......... .~..being duly sworn, deposes and says t is the applicam (Name of inUividua] signing contract) above named. He is the .......................... ~~ ............................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, a~ 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 that the work will be performed in the manner set fo~h Jn the application filed therewith. Sworn tobefore me this ....... ~o~ary,Publ~, ..~~'...~ ........ Coun~ i,.~......J..~ ............ ,. ....... Z' ": .................. ' ....... ~ /~-- //, I I~ ~ k /Z ~ ~ ~/~ ~ignature ot appncantl