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HomeMy WebLinkAbout9748-z FO~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.. Y. B~JILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9748 Z Date ...~lf~. ....... 2~ ................................. , 19...Z.8. Permission is hereby granted to: ....... ~n..F.o~k..F.~nc.~...~.~., ............................ ....... a./~., l~.....& ..l~.s ~...~eo~,g~..l~.ap~. ....... to ............ ]~X:Ld..a..fence. ................................................................................................................ at premises located at .......]~.Q~i......l~.~..h....l~..~...B..~...v..~..t ...................................................................... .......................................... ,2~u.thold,...New...York .......................................................................... pursuant to application dated ....... ~X ........~.~. .............................. 19....?.~.., and approved by the Building Inspector. Fee $ ...... 19;'00 ...... Building Inspector 1000-87-3-36 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE 5OUTHOLD, N. Y. Examined ....~.~ ........~ .................. 19...7..8. Approved .... ~y. ....... gS. ................ , 19...7,.~, Permit No, ,~,,~',,~,~ ........................ Disapproved a/c ........................................................................................... ~_~_. (Building Inspector) Application No. 9748 APPLICATION FOR BUILDING' PERMIT Date Mg~ g3 1978 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 o~ areas, and giving a detailed description of layout of property 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 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 buildlngs, 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 in, buildings for necessary inspections. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................ ~ ~.~.~..~ ........................................................................................................................................... Name of owner of premtses ...... ~.....~....~fl.,....g ....... ~ .......... ~P ......................................................................................... ~f applicant is a corporate, signature of duly authorized officer. ........................... S.,...~.flr.~J.~P.n~ ................................ (Name ond 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. Mop Ho.: ........................................Lot No ......................... Street and Number ..... tg.0.~..I$.~.e.h.~&..~.%M~.~.,..~]~Ol~i~R,,,~ ....................................................... Municipali~ 2. State existing use and occupancy of premises and intended use ond occupancy of proposed construction: ~. Exisiting use and occupancy ........ Da~=~,~l~y:.J~.l~.Ilg .......................................................................... b. Inte,ded use and occupancy ... Ome.~%e~iX%' .d.w~ll%~ .[.[ ............................................................... 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration-. Repair .................. Removal .................. Demolitior ..................... Other Work .~,,......~..? ......................... ,,/[Description) 4. ["stimated 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 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 ..................................................................................................................... 10. Date of Purchase ........................................................Nome 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 . ........................... WiJ.l~-excess fill be removed from premises: ( ) Yes ( ) No 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, end show street names and indicate whether interior or corner Iol. STA'I'E OF NEW YORK,, .. ~ S S .................... ,~2_....5....~.?...~.~..F...~..,~.~..~ .......................... being duly sworn, dopos~s and s~ys that he is the (Name of individual signing confrdcf) He is the ......................~..~..~.~.~.~.~. ........................................................................................................................ (Contractor, agent, corporate officer, etc.) of sc;id owner or owners, and is duly authorize~ t0 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 tha~ the work will be performed in the manner set foffh in the' application filed therewith. Sworn to before me this ...~..~, ....... ~ o~ ......... ~.~ ............... , ~8 ..... ~ - - ~o~a~ ~,~, . ................ ~.~..~.~ ....... ~o~ ....... ~:~:~....:,..M~/Z~......::. .::. .......... , ..................