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Home My WebLink About6521-z FOIL~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT Ci'HIS PERMIT MUST 13E KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) (~52~. Z Date ...................................................... 19 ........ .................................................... · Z.~'.y~ ...... /~z~.~e~ ........ ~'o-~-:t~ ................................... at premises located at ............................................ ;~o~j.~r./z/.~T~z~ ............................................... ................... · ~:-~'-r'--'-/ ............. ' ~;'~ ~'~,z"' v,;;;~;; ........ r~);;'~"'2'~'.~'~ ................................ ........................................... '~'"'~' .............................. ~7"~'~'F~ ......... 73 ...................................... pursuant to application dated ....................................................... , 19 ........ , and approved by the Bt:ilding Inspec.~ . Fee $ ........................ Building Inspector Approved FOR~I NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFIGE SOUTHOLD, N. Y. Disapproved a/c .................. ~~., ..:,..; ................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a This application must be completely filled in by typewriter or m ink and submitted in trlphcate to the Building Inspector, w 3 sets of plans, ~curate 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, giving a detailed description of layout of property must be drawn on diagram which ~s part of this application. c. The work covered by th~s apphcat~on may not be commenced before ~ssuance of Budding 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 Inspect~on throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certlhcate of Occupancy shall have b granted by the Building Inspector APPLICATION IS HEREBY MADE to the Building Department for the issuance of a ~uddmg Permit pursuant to the Building Z, Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the constructlo buildings, additions or alterations, or for removal or demolition, as herein described The applicant agrees to comply with all applicable la ordinances, building code, housing code, and reguJatlons, and to admit authorized inspectors on premises and in buddings for necessary mspect~o (S~gnature of applicant, or name, ff a corporation) · .P,. ....... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bull( ......................... ...... ................................................................................................ Name of owner of premises ....... ~),.~.-~.. ......... .,~ ......... O.',..C.%~Z,/~J~f ............................................................ If applicant is a corporate, signature of duly authorized officer. '~ IName and title of corporate officer) Builder's License No .......................................................... Plumber's License No ......................................................... Electrician's License No ..................................................... Other Trade's License No ................................................... 1. Location of land on which proposed work will be done. Map No...¥i:~)..~..~ .......................... Lot No.l..i..~I ............... Street and Number-.~4~-~-~...T. ............ {~.J~ .............................................................. ~~1.-~ ....... 2.State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .................................................................................................................................. b. Imended use and occupancy ............ ~-~.,;2~ ................................................................................................ 3. Nature ~f work (check which applicable): New Building ....................... Addition ..................... J~lteration.;. ........... O Repair ......................... Removal ......................... cmo itio ........................ Other Work ................................... (Description) 4. Estimated Cost ..... ~.[~. .................................. Fee ................................................................................................ (to be pa~d on flhng th~s apphcatlon) 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 occuoanc¥, specify nature and extent of each type of use .................................... 7. . Dimensions of existing structures, if any: Front .....................Rear ........................... Depth ................................... Height ........................................................... Number of Stories ............................................................................. D~mensions 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 Former Owner ........................................................................... 11. Zone or use district in which premises are situated ................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........ ~ ........................................... ' ot be reoraded ~ I'~.. Will excess fill be r~moved fro ,premises' [ ] Yes I No 13. Wdll 14. Name of Owner of pram,sas ..~'I~.C~..,).....~.'~ ...... ~ ................................................................. (Address} (Phone No.) Name of Architect .................................................................................................................................................... (Address) (Phone No.) . Name of Contractor ~.~......t~...~.~,p..~...~.....~..~...~:...~.[..t~....~...[~.... ...... ~; ..... ...~...~...'.~.~...~. (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. t STATE OF NEW YO[7~ .~/.7 . /~ ) (Name of mdt ~/dual sz~ing contract) · . bmng duly sworn, deposes and says that he is the applicant above name, He ~s the (Contractor, agent, corporate officer, crc of sa~d owner or owners, and Is duly authorized to perforn~orr~ave performed the sa~d work and to make and hie th~s apphcation; that statements contmned ~n th~s apphcat~on are true to tlhe be~lL~,'h~s T<Htl3f~tge and behef, and that the work wdl be performed m the mare set forth ,n the apphca~lon f,led therewith Notary Publlc,,~.(¢: