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Home My WebLink About6992-z ~0~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N~ Y. BUILDING~* PERMIT (THIS PE~RMIT MUST BE KEPT O,I',1 THE PREMISES uNTIL FULL COMP'LETION OF~THE WORK AUTHORIZED) Permission is hereby granted to: ~.,,,.~...~*.~z..~.~...~..~.,,-.-.~..~,,-~'~ ~o ...~~.~.~.~..~ ..... .~.~.~:z: ...... o~......,~.o.,,..-~... ~~ ' · ......... ~....~:~ ....... ~~~ .................................... ., ~,~,~.,ed., ..... z.~....~~ ...... ~ ............................................. ........................................................................ .................. Building Inspector. Examined Approved ........... ~.: ............ /....~.. ...... , TOWN OF SO;THOLD BUILDING DE,P~RTMENT~ TOWN CLERK S OFFICE SOUTHOLD, N. Y. ...... ....... Disapproved a/c .................................. ~.. .................................... : ................ ~ui Leff'r~g Inspector~ APPLICATION FOR BUILDING PERMIT Date ......... INSTRUCTIONS a Th~s apphcat~on must be completely hlled In by typewriter or in ink and submitted m tnphcate to the Bu~lding Inspector, w 3 sets of plans, accurate plot plan to scale. Fee accordmg to schedule, b. Plot plan showing location of lot and of buddings on premises, relationship to adjoining premises or pubhc streets or areas, ~glwng a detaded description of layout of property must be drawn on d~agram which ~s part of th~s apphcat~on. c. The work covered by this apphcat~on may not be commenced before ~ssuance of Budding Permit d. Upon approval of this apphcat~on, the Building Inspector will ~ssue a Building Permit to the apphcant. Such permit ,shall be kept the premises avadable for inspection throughout the work. e. No budding shall be occupmd or used m whole or tn part for any purpose whatever until a Certificate of Occupancy shall have b granted by the Budding Inspector APPLICATION IS HEREBY MADE to the Budding Department for the issuance of a Budding Permit pursuant to the Budding Z, Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the constructlo~ buddings, additions or alterations, or for removal or demolition, as hereto described The apphcant agrees to comply w~th all applicable la ordinances, budding code, housing code, and regulations, and to admit authorized inspectors on premises and ~n buddings for necessary inspect~o (Signature of apphcant, or name, ~f a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build Name of owner of premises .~.~,~ ......... .~f--~--~.L~"~t-~;~.~ ......................................................................................... If applicant is a corporate, signature of duly authorized officer. ~Name and title of corporate officer) Builder's L~cense No .......................................................... Plumber's License No ......................................................... Electrician's License No ..................................................... Other Trade's L~cense No ................................................... Z. ,~z'~ 1. Location of land on which proposed work will be done. Map No...:;~ ...... ~...;~ ........................... Lot No ....................... Street and Number ..,~._.._,__ ......... ~,,~,.).~1,,~':~' ................................................. g:~l~l~.~i~.~-~;~ ........ 2.State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... .~d,~'.~.~.....~...h.~....'~'...~...4~./...../...~-_~-~....~ ................................................ Intended use and occupanc ....... ~,-,t,~.~'T .................... ./........'"" .............................................................. b. ~(f,....~ 3. Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration...'...;. .... Repair ......................... Removal ......................... Demolition ........................ Other Work ~"'~'~'~ (Description) 4. Estimated Cost ............................................... Fee ~ '~ ~ (to be pa~d on flhng this 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 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 ........................................... r .... Number of Stories^....?... ................................... ~ ............ ~ ...... 9. Size of ot' Front ...... ~..~...~...:...~.. ............. Rear ...... !....~...~:~....,~.'~.. ................... Depth ......... ,.~,.,.~..:..,~.. ...... '~'~':~':,~': 10. Date of Purchase ..................................... Name of For~e.r.~fOw~ner ........................................................................... 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 ...... ...~.,.~..~ ............... .A~Vill e. xcess fill be renQo~/ed fro~m, pr~e~r0.~..s: [,~ Yes ~r~] ~ 14. Name of Owner of premises ..~..~.. ......... ..~'...O...~....~...~...'~.....~..~ ..... .~..~.....~?..! ...... ..~.~.: ...... i.~...?...?...'...~..~..~.. (Address) (Phone No.) · , Name of Architect .................................................................................................................................................... ( dres IP No.) Contractor Name ....................................................................................................................(Address) 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, STATE OF NEW .Y/C) ~/~,//.~/j/~' ................................................... being duly ~worn, deposes and says that he ~s the apphcant above name, (Name of tnd~mdual sz~.~g contract) He ~s the ................................................................................................................................ (Contractor, agent, corporate officer, etc } of sad owner or owners, and ~s duly authorized to ~rform or have performed the sad work and to make and file th~s apphcat~on; that statements contained m th~s apphcat~on are true to the best of h~s N~I 8~c~ ~n~o~hat the work wdl be performed ~n the mare set forth m the apphcatlon fded therewith Nc ~2-0344963 Suffolk Counl~ Notary Pu bl,~~