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Home My WebLink About9657-z TOW~ BUILDING DEI~ARTMENT TOWN CLERIC'S OFFICE SOUTHOLD, N.. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES 'UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne 9657 Z Date ........................................................ , 1 '2 ........ Permission is hereby granted to: at premises located at ............... :'r. ....... i .................................................................................................. L O ~-'~, } ?/~'/~'; ~- ,"~o~ ~<~ F/,'a/} /,~ a ,:, ~' 112", 5 6 p.r~.~n~ ~o ~pp,c.~o. ~a ................................ ....-..----.....-..., ~ ....~d ~pproved by ~he Building Inspector. Building Inspector FOZ~r ~O. Z TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ................... .~.~( ........ ~'5 .......... / Application No. (~ . . ............ ~proved ........................ ~ ............ :., I~ ....... ~ ~ermir No. Disapproved a/c ......... ;.~:~ .... =. ................................................................ (Building Inspector) ............................. INSTRUCTIONS a. This epplicmion 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 ~ale. Fee according to schedule. b. Plot plan showing location of lot and o~ buildings on premises, relationship ~o adjoining premises or public s~reet~ o~ areas, and giving ~ detailed description of layout ofproper~ must be drawn on the diagram which is pa~ o~ this eppHcati~n.~ ~ 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 per'it shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in pa~ 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 demo t on, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building c~e, housing code, and regular OhS, and to~ admit authorized inspectors on premises and in buildings for n~essaW in~ectJons. T~]~ PORK P~CE CO.~ I~C. '"~[~'~'~'J;;';~";'~plicant, or name, if a ;;';~';';~;i;~'~ ........ ....... ............ (Address of applicant) STate whether applicant is owner, lessee, agent, architect, engineer, general contractgr, electrician, plumber or builder ~obe~ ~a~lne Name of owner of premises .................................................................................................................................................... If applicant is a corporate, signature of duly authorized officer. ......... .................................................. (Nome and title of corporate officer) Builder's License No ..................................................... }(p lb Plumber's License Electrician's License No ............................................. Other Trade's License No. ' ~b'~zxz ~'~ Location of land on which proposed work will be d. one. Map No.:.; ....................................... Lot No ...... ~ ............. Street and klu~k~r ~O0~le ~p~.'if O~ ~/O Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy b. Intended use and occupancy Q~.~.~.~.m. ily..d.}felling . 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolitior ..................... Other Work .~.e...~..{I.$.~l~ ................................... (Description) 4. Estimated Cost .....~..]....~..~...0..,...0..0. .......... ~./....~..~.~.'.'9. ........ Fee ..... .~. ~. .,. .0. .(}. ........................................................................ (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 ......... ],¢0.1. ...................................... Rear ........ ].~0.t. ......................... 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: ........................................................ 13. Will lot be regraded. ........................... Will excess fill be rem°ved~ir~°~ale~re~J'Lse~("~" "-~'u.~ ) Yes ( ) No 14. Name of Owner of premises .~.C)h~.t~..~.Z'~;J.~l ................. Addres~tl,4r/~l~Ol~,elll.i.,.~r... Phon~ No. ,i 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 Io~. COUNTY OF ...... ~.O1~' ......... ~ .... t ? ~ t ' ' ............................. ~.,...~.~ ....................................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. (Contractor, agent, corporate officer, etc.) 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. 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 to before me this ~ . _ , , , ,' ,~ ~RY PUBLiO, State at ~e~ ~6r~