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Home My WebLink About6662-z FOF, M NO. 2 : TOWN OF SOUTHOLD BUILDING DEPARTMEN~T TOWN CLERK'S OFFICE SOUTHOLD, N~. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne 6662 z Permission is hereby grartted to: ..... ~Z~.....~.~..~:~...~ ....................................................... ~ ............................................................ at premises located at ....... J~j~,~l~&,..]jJlJ..~J~.-~&~]J-..~,y~! ............................................................ pursuant to application dated Building Inspector. ) ....... , 19.~.~..., and approved by the Examined ..... ~...~.. ..... , Approved .... ~ .............................. , FORM NO, 1 TO~VN OF $OUTHOLD~ BUILDING DEPARTMEI~T TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 192..~... Permit No(./~?..:.~.....~..~m ............ APPLIC-&,TION FOR~ BUILDING! PEP./~IT ~ Date ............. ~NSTRUCT~ONS o. This application must be completely filled in by typewriter o~ i~ ink and submitted in triplicate to the guilding Inspector, with 3 set~ of plans, accurate plot plan to scale. Fee accordin~ to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to od oining premises or public streets areas, and giving a detailed description of layout ofproperty mu.n be draw~ on the diagram which is part of this appfication. 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 issu~ a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the w~rk. e. No building shall be occupied or used in whole or in part for any p~rpose whatever until a Certificate of Occupancy shall have been granted by the ~uilding Inspector. APPLICATION IS HEREBY MADE to the Building Department for thb issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, Ne~ York, and other applicable Lows, Ordinances or Regulations, for the construction of buildings, additions or alterations oF for removal or demolition, as herein described. The applicant agrees to comp y with all applicable taws, ordinances, bui(ding code, housing code, and regulations, and to admit authorized inspectors on premises and in, buildings for necessary inspections. (Sionat~ure o~ ~pplicont~ or nome, ~f o corporOtion) 5.:: ............... : ............................... (Address or opplicant) State whother *ppl~ont is owner, lessoe, ~Oont, orch~toct~' en~ineer~ ~enOral~ contractor electricion~ plumbor or builder .... .................. ........................ If opplicont is o corporotot si~noture of duly outhorized officer. (Nome ond title of corporoto officer) Plumber's kicense ~o ................................................. [lectricion's kicense Mo ............................................. Other Trode's kicense ~o ...............................................X? ........... ............. ' ..................... Municipality 2. State existing use and occupancy of premises and intended use~d oc~pancy qf~roposed construction: a, Exisiting use and occupancy ..... (~ ....... , ........ z .............................. b. ~.te~ded ~ ~d oc~.~y ............. ~ ................ ( .......... ~ ....................... ~....~. ........... :.~.:. .~.~. 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration ............... Repair Removal Demolition .................... Other Work '-~.~.~" (De ption) 4. Estimated Cost ..................... .~.~.....~.....~..:...C~.~ ........... Fee ......................... ~..~.~...~.....~....~. ........................................... (to be paid on filing this application) 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 .................... Number of Stories .................................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ............................... 10. Date of Purchase ........................................................Name of Former Owner ........................................................ 1 ]. 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 ............... ~......I. ...... Will e~<c~ss fill ~be removed from premises: ( ) Yes ( ) No ]4. Name of Owner of premise .. .,.. 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 from property lines. Give street and block number or description according to deed~ and show street names and indicate whether interior or corner lot. STATE OF NEW,~'OI~,/~ J~ ~ COUNTY OF~ ............... ................................................................................................. being duly sworn, deposes and says that he is the applicam (Nome of individual signing contracf) above nemed. He s the ~~.~. .......................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements 6ontained in this application are true to the best of his knowledge and belieF; and tha~ the work will be performed in the manner set forth in the application filed th~with. Sworn to bef~me this ~ ............. ....... ,...., 'otar Pub c ~JJt~ .~,~,~ y , ....... , .............. ~ JUDITH T. BOK~N (Signature of applicant) Notary Public, State of New York No. 52-0344963 Suffolk Couniy Commsson ~x~J[~ March 30~ 19~