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Home My WebLink About9643-zBUILDING DE~P~RT/',~ENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERM, IT (THIS PERMIT MUST BE KEPT ON THE P~.EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 96 3 Z Date ........................................ : ........... .~.., ........ Permission is hereby granted to: at premises located at ............................................................................................................................ /~,q1~t ~7 19..:.~.., and approved by the pursuant to application dated ........................................................ , Building Inspector. ,Fee $ ........................ Building Inspector 0 co TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~OUTHOLD, N. Y. E×am,ned .................... proved ............... ,97 . ,ermi, No ...... Disapproved a/c .................. ~~ ............. (Building Inspector) Application No....?.....~.....~....~.. ............ APPLICATION FOR BUILDING PERMIT Date March 27 19 78 INSTRUCTIONS a. This application must be completely filled in by ~pewriter 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 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. (Slgna(~e 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. .................. ~g.e..~.~. .................................................................................................................................................................... Name of owner of premises ...~...~.~..'....~...O..}?-...~.....~..;....D.D..~.~..O..~. .................................................................................................... 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.....~/..A.. ................................... Location of land on which proposed work will be done. Map No.: ........................................ Lot No ......................... Street and Number ~2.~7~.~.e.~c~.~.~.h.~.A'~.~'.e.~n.~.~9~:~.~.~.~.?~'~.~qe.~ .................................................................. Municipality State existing use and occupancy of premises and infended use and occupancy of proposed construction: a. Exisiting use and occupancy Hoase a~c]..g.a~a~e w±th an~encecl. ~a~d b. Intended use and occupancy ....~...e..q..a..e. ................................................................................................................ 3. Nature of work (check which applicable): New Building'. ................. Addition .................. Alteration ...~.. ...... ~ ,, Repair .................. Removal .................. Demolition .................... Other Work ...,.~..e...z3.~.e.. ................................... (Description) 4. Estimated Cost ........ ~.5..Q.0.. .......................................... Fei ........................................................................................... (to be paid on filing this application) 5. if dwelling, number of dwelling units ............................ N~m~ber of dwelling units on each floor ............................ If garage, number of cc~s ............................................................................................................................. 6. If business, cornmer¢iu[ or h~xed occupuncy, specify nature crud extent of each type of use ............................ 7. Dimensions of existing structures, if any: F~ot,t ........................... Roar ................................ Depth .................... Height ........................ Number of Stories .............................................................................................................. Dimensions of same structure with alte~ahons or ,ddilion-s: F~ont ....................................Rear ............................ Depth ................................ Height ........................... Number of Stories ................................ 8. Dimensions of entire new construction: Front ............... , ............ Rear ............................ Depth ........................ Height ................... Nurnbe~ of Stories .................................................................................................... 9. Size of lot. Front ...................................................... tLe,~ .......................................... Depth ................................ 10, Date of Purchase ........................................................ Name et Former Owner ........................................................ 11. Zone or use district in which premises are situated ...'.~,.~.]~...,]~kt~i~f~,.~ ..................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ...~..o..: ................................................ 13. Will lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises ..~..~.s..:.....3..o...h..~....~.......D...~.W.S...o..n. ..... Address Q.t,t.~.g,l~Qg.~,.~.,...,~. Phone No ....................... Name of Architect ......................................................... Address ................................ Phone No ....................... Name of Contractor ._~...w..~.n.....~...o..~..~.,~.?..~..c~? ................ /\ddress .M..a..~..i..~..u..~.t...~.~.. Phone No ....................... PLOF DIA£~iRAM 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. SEE ATTACHED SHEET STATE OF NEW YORK, I c c COUNTY OF ................... ~I.a..~..~.....E.........D..~.?..~?,,~. ........................................ be,a~j duly sworn, deposes and says that he is the applicant (Name of individual signing contract') above named. He is the ....... Ag.e,n.~. ........................................................................................................................................................ (Contractor, agent', corpor~te officer, et'c.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this applicetion are true to the best of his knowledge and belief; and tha~ the work will be performed in the manner set fo~h in the application filed therewith. ............ ~3.~... day of ...~.~. ............................ , 19...7.8 Notary Public, ....~.~9.~,.. ~ ............... County .- (Signature of applicant) ............................