The URL can be used to link to this page

Home My WebLink About10106-z FOI~V~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH:OLD, N.. Y. BUILDING PER~IT (THIS PERMIT MU. ST BE KEPT ON THE PT~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 10106 Z Permission is hereby granted to: .~.~..q........d......~..O.~..~..b.!.D!.~t. ......... ..L..!...V...~ ~ ~ ~ ........ .~L?...~..7.. ........... ~.~.i~ ....... ~ .................. ..................... .L.:~ ~.~.~.~.:.-.~. ~ ................ .~!..:.C.. ~o ......... r.~ ......... ...~...~ ......... ~.~.z~. ........... ..A........~..~.~.:..~...~ ............................... et premises located at ................ ~...~...~. ........................................................................... ~ .............. /~ n --/-~/ T-u c/~.. ........... T;':i: ........ ................. pursuant to application dated ........................................................ , 19 ........ , and approved by the Building Inspector. Fee $....../.~ .............. E~uilding Inspector FO~M ~0o 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ................. ,~.K..."~....% ............ 19...../. _ Apphcat.on No ................................. proved ............ er, o ~., 19.....~.. P m't N ..................................... Disapproved a/c ..............~' .............. ..;~ .................................................. APPLICATION FOR BUILDING PERMIT~,,~ ...... /...,/ 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 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 Deportment 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, os herein described. The applicant agrees to comply with all applicable lows, ordinances, building code, housing code, and regulatioqs, and tog~ admit authorized inspectors on premises and ir~ buildings for nec~y inspections. ' ...... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ~ ~Z¢ ~ 6'~ L t ¢' f~ J~ O g If applicant is a corporate, signature of duly authorized officer. Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1. Location of land on which p~oposed~/[,,,,~ --I/ _/ //Z~ ~/~grk will be done. ,JV~ap No.; ../..~../...'.,~.....'::'.-- ), ............. Lot No...../.~.,. Street and Number ..... ~'...~). ...... Municipality 2. State existing use and occupancy of~mioes and in,end.~ use a~.~d occupancy of proposed construction: · .... .............. 3. Nature of work (check which applicable): New Building'. ................. Addition ........ ~;L)' ..... Alte~a~tion ................. Repair ................. . ~temoval .................. Demolition .................... Other Work ..... .~...?..-z.~.(...%~' ..................... ,... ., (Description) · 4. Estimated 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 .................... Numb_~er)~°f Stories ...................................................... ___-- !'~ ................................. :__~,</ ............................ 9. Size of lot: Front .......... ~....~. ......................... x ......... Rear .......... ,,~..;..~....'.. ........ ~ .....Depth ...../,.~..~..;.. ........ :. 10. Date of Purchase ...... ~..~....':~........~.....'~..~.......~.....Name__ .~ _/ /.__ ,,.;//of Former O,wner ..0.'.~...0.~..~.,..... '.~.,~'.J/~....~.....~... 11. Zone or use district in which prer~ises are situated ............. ~.'f~-.~..Z..~...~..~4~.....c:...~'...~..;'..fw,~ .................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ ).-~ ............. 13. Will Jot be regraded ....~'J~:Z),~(, ......... __~Will excess fil~l be removed from premises: ( ) Yes (~')~ No 14. Nome of Owner of premises£~'..b,~/~..~.../-.~.LL)..~./~.~. Address ................................ Phone No Name of Architect '"'U'~,,-,,~ / -/ ~, ,t/""z'7 ................................... Address ................................ .Phone No ....................... Name of Contractor ..~..~..~~...: ............... Address'~')c~'~//A"?'d~'/~Phone No ....................... .......... ~Z~'. ............... PLOT DIAGRAM /~,~' Locate clearly and distinctly all buildings, whether existing or proposed, (3nd 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. [ ),o STATE OF NEW. '~RI~/.,, ..... : ....... being, (Name of individual signing c~9(racf) duly sworn, deposes and says that he is the applicant above named. He is the ......................................... ~~ ............................................................................................................ ( (C/ontractor,~;jent, corporate officer, etc.) of said owner or owners, and is dul~o perform or have performed the said work and to make and file this application; that all statements contained in this applicction are true to the'best of his knowledge and belief; and that the work will be perfor~d Jn the manner set fo~h in the application filed therewith. Sworn to b~re me this ( ~ . ~ / ........ ? Noto~ Public, .....~.mt~ ............... Coun~ "'7'~" ........... ~';'~'~'"': ................................ I ~ ff ~ ~ ~ ~ ~ ' (Signature or~pplicant) PAMELA J SCHINELL[E