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Home My WebLink About9820-z F01~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE Pi~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9820 Date ......................................................... 19 ........ Permission is hereby grunted to: l'~r, rC'...~:.,.!.~..5.. tO doted ............................. ~].~6~.~. ........ g2, 19.~.., ond approved by the Building Inspector. Fee / t~O0- Building Inspector ~r oO z r 0 FOBM~ NO, 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, iq, ¥. 75/ No ................................. Exam.ned ....................... ./~,~.. fl ........ , 19....:.../ Application q~'~ ...................... ...... · pp ed a/c ........... ~ ............................................................................ APPLIGATION FOR BUILDliqG PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Building Inspector, with 3 set~ 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 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 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, ifa corporation) L] ................................................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Owner Name of owner of premises Ma.ry. and Josep. h A, Horvath 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. Mop No.: ............... ..~. ...................... Lot No...~.~ ................ Street and Number ...~.~.~.8.~.g...?g.i..z)..~....g",J,,.'9,~.....~..9.~...~,O.¢ ................................................................... ~...q.q.~..~..o..]:.c]. .......... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy .......... ................... b, Intended use and occupancy .~.~.~..~..~.~..~.e~.c~.~.~..~..~.b.?...~.`.~'~..e~.~...~...~'~.~.~..~.p.~...~e'.~.t..~.~.~ ......................... 3. Nature of work (check which applicable): New Building'. ................. Addition .................. Alteration ............... Repair ................. Removal .................. Demolition ........... ~.._ Other Work ................................................... u~:J' (Description) 4. Estimated Cost .~. 0 I~ :~ Fee '! //0 (lo be paid on filing this application) 5. If dwelling, number of dwelling units .......................... Numbcr of dwelling units on each floor ............................ If garage, numbe~ of curs .................................................................................................................... 6. If business, commercicd ~r mixed occupu~,cy, spca.fly nc~-ure and extent of each type of use ............................ 7. D mensions of exisling structures, if any: Fro,,t ....................... Rear ................................Depth .................... Height ........................ Number of Stories .......................................................................................................... Dimensions of some shucture with al~erolions or dddhions: I'ront ................................... Rear ............................ Depth ................................Height ...........................hfumbc,' of Slories ................................ 8. Dimensions of entire new construction: Front ................. , .............Rear. ........................... Depth ........................ Height .................... Number of Stories ........................................................................................... 9. Size of lot: Front ' Depth 10. Date of Purchase .......................................... hl:m~ of Former Owner 11. Zone or use district in which premises are situated ......................... ~/--~..~..'~. ................................................ 12. Does proposed construction vialate any zoning law, orchnance or regulation: ............... ../~...,,.0. ....... . .......................... 13. Will lot be regraded · ........................... Will excess fill be removed from premises: ( ) Yes ( ) No Nome of Architect ..................................................... Address ................................ Phone No ....................... Nome of Contractor ................................................... /\ddress ................................ Phone No ....................... PLO'I DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate oil 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 Iol STATE OF NEW YORK, COUNTY OF ................................ .................. ..d...~...~.~l~.(~ ....... .~..~...V_..~.._-~..,I.~ ............. h~,~u-,g d,,ly swam, deposes end says thor he is the applicom (Name of individual s~gning conh'acf) above named. He is the ..................... ~.~.~.~..~ ~Contmcter, auent, corporate officor, etc.) of said owner or owners, and is duly authorized to perform or have performed ~he said work and to make and file this application; that aH 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 forth in the ~pplicat'ion filed therewith. Sworn to before me this ........................ aay at ............................................ , ........ II uFFO~ rt Not~ Pub c,. .......................... ~ ............ ~ Y .... ~.;;: .......... ~ .................. ~bignoture applicant) / / OT