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Home My WebLink About6841-z FOR~ 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) Permission is hereby granted to: .~ L?,.L .t.......s..c. ~.,...z.~..k. .......................................... ....... .~a.~..Jnr~ ....................................................... ............... ~te.h~g~_~e .......................................... ......... · w~mmimg..~ool ..................................................................................................................... ot premises Iocoted at ..... ,~, ,/,,~,..~.q~,..,~,~...,~Ct~:L~...~,R~R~). ............................................................. .......................................................... .......... ............................................................ pursuant to application dated ............................~.~.~.~. ....... ~. ...... , 19.~.~.., and approved by the Building Inspector. Fee ~.%~0~ ............. Building ]hn~pector / Approved ........................................ , FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 19..."~...-'~... 19..~,-~,,.~, Pemit No....~...~.../'./Z~ ....... Application No ............................... Disapproved a/c .... ~.....~ ..... ~ ........ APPLICATION FOR BUILDING PERMIT I NSTP, UCTIONS a. Th~s apphcat~on must be completely filled ~n by typewriter or in mk and submitted ~n tnphcate to the Budding Inspector, w 3 sets of plans, accurate plot plan to scale Fee according to schedule. b. Pict plan showing location of lot and of buildings on premises, relationship to adlommg premises or pubhc streets or areas, - g~wng a detaded description of layout of property must be drawn on d~agram which ~s part of th~s application c. The work covered by th~s apphcat~on may not be commenced before issuance of Budding Permit. d. Upon ,]pproval of th~s apphcat~on, the Budding Inspector wdl ~ssue a Budding Permit to the applicant. Such permit,shall be kept the premises avadable for ~nspect~on throughout the work e. No budding shall be occupmd or used m whole or m part for any purpose whatever untd a Cert~flcete of Occupancy shall have b granted by the Budding Inspector. APPLICATION IS HEREBY MADE to the Building Department for the ~ssuance of a Budding Permit pursuant to the Building Z, Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances or Regulations, for the constructim buddings, add~tJons or alterations, or for removal or demolition, as hereto described The applicant agrees to comply with all applmable la ordinances, budding code, housing code, and regulations, and to admit authorized inspectors on premises and In buddings for necessary inspect~o (Signature of apphcant, or name, ~f a corporation) (Address of apphcant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or built Name of owner of premises ...... .~.../..~...~.../.....~../...C'...~.. ........... i.-~...!..~..L...~. ....... ~3~..y:..~lJ..(.~'..~.~ .............................. 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 L~cense No ................................................... 1. Location of land on which proposed work will be done. Map No....~,'..~....~'-...~...~...~.. ..................... Lot No ....................... Street and Number .... .~....~....~.....~,...,~...,~..:....,.~...~...~././..,.¢? .~....~.,..~... ............................................................................... Municipality 2, State existing use and occupancy of premises and ~ntended use and occupancy of proposed construction: ,[ . . .I). ~ a. Existing use and occupancy ..................... ~...~;..?-...~,..~ ................................................................................. b. Intended use and occupancy .Z'.~......~././~......./..~..~...~...~.....--.....'~....~....~...~....~-~...°.../~...~....¢~..~/~ ....................................... 3. Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration ........ .~.{ .... Repair ......................... Removal ......................... Demolition ........................ Other Work ...~,,.,//~ ,~',,~,, ....... ,~, ;,~,,~....L.. ~:'Agtg~2f/~ /~L~/, ~ ~/$'/~,.z//''- ,49.4~/~ /~',~'/f/'~".~' /t,/'~9/~/""'/r/ ,J~/.CP~.-~ ~/~ /~EO~'~"~ (Description) - ......................................... Fee .../. ........................................................................................... 4. Estimated Cost .~...~...--~ (to be pa~d on hhng th~s apphcat~on) 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 occuoancv, 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 ...................................... Rear .......................................... Depth ................................................ 10. Date of Purchase ..................................... Name of Fo,,rmer Owner ..: ........................................................................ · , . 1 1. Zone or use district in which premises are situated ..../~J ..... '~,,,':~,,J, .......................................................................... 12, Does proposed construction violate any zoning law, ordinance or regulation: ...... x~..~,, ........................................... 13. Will ~ot be regraded ....... ..~..~..~.-- ............. _Will excess fill be removed from preAnise~,/[fl ] Yes [ ] No 14. Name of Owner of premises ..... ........... ............................. (J ~ (Address) (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 fro property lines. Give street and block number or description according to deed, and show street names and indicate whet er interior or corner lot. COUNTY or ..... ~.:L:.. ~ , being duly sworn, deposes and says that he Is the apphcant above nam (Name of ,ndwtdua/ ~ ~ ;o~ ~ac, ) ' ~ '" ,, ......... .... ............. (~ontractor, agent, corporate officer, etc ) of smd owner or owners, and ~s duly authorized to ~rform or have performed the sa~d work and to make and file th~s apphcatmn; tha statements contmned m th~s apphcaBon are true to the best of h~s knowledge and behef, and that the work wdl be performed m the ma~ set forth m the apphcat~on filed therewith . .......................................... (5t~ature of appffcant)