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Home My WebLink About6263-z FOI~M NO. 2 TOWN OF SOUTHOLD BUILDING DEPART/v~EN'~ TOWN CLERK'S OFFICE' SOUTHOLD, N; Y. BUILDING PERMIT (TH~S PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 6263 Z Permission is hereby granted to: T~,~a...Fork...F~ee..6e.....*/~..-T{obev~...Ba~yley ............... -~'?.t~'..~ _k. ....................... , .................. at pr~mis~ Iocat~ at ..... ~/~..~...~.,.~y~ ................ ~ .......................................................... ............................................ ~u~oE~¥ ..-.~. ~.¥., ....................... t ........................................................... pursuant to application dated ........................... ~ ..........~ ......, 19.~.., and approved by the Building Inspector. Fee $..i:~..00 ........... TOWN OF SOUTHOLD /, BUILDING DEPARTMEN'r TOWN CLERK'S OFFICE $OUTHOLD, N. Y. Examined ~ '7 Approved .................... h;...,~..~ ......... , 19..,,~!.. Pemit No, Applico~io~ No ............. 2 .................. Disapproved a/c ............................................................................................ ....................... ................................ (Building Ins~ctor) APPLICATION FOR BUILDING PERMIT INSTRUCTtONS a, This application must be completely filled in by typewriter or in ihk and submitted in triphcate to the Building Inspector, 3 sets of plans, accurate plot plan to scale, Fee according to schedule, b, Pict plan showing location of lot and of buitdmgs on premises, relationship to adjoining premises or public streets or areas, giving a detailed description of layout of property must be drawn on 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 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 shell 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 ZonF Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with al~ apphceble ordinences, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections~ (Signature of applicant, or name, if a corporation) (Address of applicant) State whether apglicant is owner, lessee, agent, architect%e, ngineer~ general contractor, electrician, plumber or builder. ................................................................ ............................................................................... o, o, ...... ....... ............... ...... ............ ...... If applier is a corporal, si~~ed officer. ~ · +/ ~..~ u ~ '~~']~it~b r~te o~fJ~;i ..................... [oc~tion of I~nd on w~h proposed wor~ will be done, ~p No.: ,,,~...,...,...., Lo~ No, ~..~.,~....,,..... .... Stree~ ~nd Number ,.~.Z ....... ~ .~.,, - ..~, ~..,-~.W, ~, .......... ~-~ ~-O..~...= :~vmnicipmiw: .............. 2, State existing use ~nd ocaupaney of gremi~s ~nd (htended use and oeoupane~of proDpsed~struation: D, Intenaea use anti occupancy ........................ ,, .............................................................. ~ .................................... ~ ............... Addition ..................... 'Alteration ............... ...... va. ......................... Demolition ........................ Other Work .............. (Descripth ~n) 4. Estimated Cost ........... ~ .............. Fee .,..,/,,,,~....,.: ................................................................................. (to be paid on fiJing this appJication) '~lf dwelling, number of dwelling units ................. Number of dwelling units on each floor ............ i ............... J .......... ~f~rage, number of cars ................................................................................................................. ~ .......................... 6. If bu~ss, commercial or mixed occupancy, specify nature and extent of each type of use ..................................... ~imensions of existing structures, if any: Front ..................... Rear ........................... Depth ................................. Height ........................................................... Number of Stories ........................................................... Dimensions of same structure with alterations or additions: Front ........ ~ ......... Rear ,.~ ............................................. Height ......................................... Number of Stories ................................. ions of entire new construction: Front ......................... Rear ............................ Depth .......... 9, Size of ot'~ront /~ ~..¢~.~. ..... Rear ,,~,~,~,,I~,.~.~ ....... Depth ,~.,~....~ ~,.,~.~.~,~ Height ...~.....~....~ ........ Number of Stories ......... / ................................................................... J¢.. 10. Date of Purchase ..... 1.~..~ ............... Name of Former Owner ........................................................ 13. Will lot be regraded ..................................... Will excess fill be removed from premises: [ ] Yes [ ] ~o 14. Name o~ Owner of prem,ses ....~.~.~.~=~ ......... ~.~.~.-..t~.~ ............................................................. Name of Contractor .................................................................... ~.~;.) .................................... ~F~;~'~;]'~ .......... "~ Locate cleaHy and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensid,ns from property lines: Give street and block number or description according to deed. and show street names and indicat~ whe~- er interior or corner lot, .0~ ~ ~ ~ ~ -- STATE OF NEW Y~RK~. ~, // ) ~ ~ COUNTY OF ...... ~,.~,. I~,~.~ .................. ) ~ (Co~tr~ctor, ~mtt, co~por~te o~icer, etc,/ ~ of said owner or owners, and is duly authorized to perform or h~ performed the said work and to make and file this application; that ~ statements conta ned n thru .~pp ~c t~on are true to t~ ,be~¢o~ {~ ~e and behef; and that the work will be performed in the mann