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Home My WebLink About692-z FOI~M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.° 692 Z Permission is hereby granted to: ...... W~[II[~' ' ' ' W, 8'~'~ 6¥~'~' ................................... ~,~t'~itaok~ ~.Y, ' B~I~" ~'"6~"'~il~'"~'ii'ig~ ........................................................................................... at premises ~ocated at ~.¢..~..~...~/~...~..~ ........................................................................ p~rs~eat fo gpplicetio~ ~eted ................................................................ 19 ........ , oad epproved by the ~il~ing Inspector Fee $"~00 ............ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No ...... ~' .~...~ ..... (Building Inspector) APPLICATION FOR BUILDING PERMIT Dote ..................................... 19 :. ........ INSTRUCTIONS o. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. 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 of property must be drawn on the diagram which is part of this location. 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 progress of 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 issuanoe 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 a Iterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulgtions. (Signature of applicant, or name, if o corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..................................................................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) I. Location of land on which proposed work will be done. Mop No: ..................... r ...................... Lot No:~.. .................. Street and Number .... ; ...~!:."'~..~:.:.~.? . ............................................... ; ..................................... Municipality 2. State existing use and occupancy of pr, emises and intended use and occupancy of proposed construction: V~., c'a~tt la~d a. ExisHng use and occupancy private dwellin~ b. M~ended use ~nd occupancy property lines. Give street and block numbers or description according to deed, whether interior or corner lot. 3. Nature of work (check which applicable): New Building....~ ............ Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost...~l~00 ............................................... Fee ~1~,.0~ ................................................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units.....l~i~.,~ ..................... Number of dwelling units on each floor ............................ If garage, number of cars ......................... rm~ ............................................................................................................. 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 .............................. H~ight .............................. Number of Stories ................................ 8. Dimensions of entire new construction: Front......(~ .................. Rear ........ 62 ................ Depth ...~1~ ..................... Height ............................ Number of Stories ..... ~ ................ 9. Size of lot: Front ......~.~[i ................ Rear .~1~,~ ..................... Depth ]~?J./..~L~Z~ ........... 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in v~hich premises are situated ................. ~?...a~_~:t, ............................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ....... ~ ......................................... 13. Name of Owner of premises.~..~r.¢~i~,.~ ............. Address ..~h~%¢~%~t~ ........................ Phone NO ..................... Name of Architect ........................................................ Address ............................................ Phone NO .................... Name of Contractor .................................................... Address ............................................ Phone NO ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from and show street names and indicate STATE OF NEW/Y~D~,K/~ )~' S S "! ' ,, .................... ~~'~.~ ................ bein0 duly swarn, deposes and soys that he is tho, applicant , (Nome of individual signing opplic~on) , abow, named. He is the ................ ~ ................................................................................ ; ..................................... (Contractor, agent, corporate officer, etc.) ~ of said owner or owners, and is duty' authorized to perform or have performed the said work and to make~ and fife this application; that all statements cbntained in this application are true to the best of his knowledge g~ belief; and that the work will be performed i~n the manner set forth in the application flied therewith. .~ ~ Sworn to before me this / / ~' Z; " .... -' '