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Home My WebLink About6333-z FORM NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICe:. SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISE', COMPLETION OF THE WORK AUTHORIZED) UNTIL FULL N? 6333 Z Permission is hereby granted to: ~ .......~¥~~..~....~........~.:.. .................................................. .~ ................................... ~../.. .......... o . m , . e. , o , . . . . . . . . . . . . . . . m/ ' ........................................ ~,~.~.,..~.~~, ...... ,,~.,..-:, .......................... ~ ........ pursuant to application dated ..................... ,...., 1 and approved by the Building Inspector. Fee .................. Building Inspector TOWN OF $OUTHOLD BUILDING DEPARTMENT~ TOWN CLERK'S OFFICE SOUTHOLD, N. Y. FOI~M ~tO, ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Yo .................. ....... , .................................. ~isopprovod o/c ............................................................................................ ........ r (Buildino Inspector) Application No, . .~,..~... ~., /---- APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or m ink and ~ubmitted in triplicate to the Building inspector, with 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, re[ationsh!p to adjoining premises or public streets or areas, and 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 wdl issue a Building Permit to the applicant. Such permit,shall be kept on the premtses 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 shall have been granted by the Building Inspector. APPLICA'T~ON IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or aherations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit au thorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) il ' est Z~6hh SL , t Y. ]0036 (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder, Name of owner O[ presses ¢<-z~:f '?~.'~ ~o :,~( ~ ......................... ~..,~~~, ~. .......... ..................... Builde/s License No ......................... Plumber's License No ......................................................... Electdc~an' s L~cense No ..................................................... Other Trade's License No ................................................... ~ ,~, ~ / t Location of d on whmh proposed work wdl be d~ne. Map No ........ ~ ............. ~ .................... Lot No ..................... Municipality 2. State existing use and occupancy of premises and intended use and o~cupancy of proposed construction: a. Existing use and occupancy ....~{:~.(~ii~.~::~:~:~.~.t:~ ........................................................................ b. Intended use and occupancy ....................................................... ~ .......................................................................... l~pture ;f work (check which applicable): New Building ....................... Addition .................... ,~<,~/ ,,-~".J~Alterati°n'~"*'""":~: ......................... ......................... ........................ ......... : .* /D-'~-O' ~ Fee ................................................................... Estimated Co ................................................. (to be paid on filing this application) If dwelling, number of dwelling units ................. Number of dwelling units on each floor ............ If garage, number of cars ............................................................................. ~ ................................. 6. If business, commercial or mixed occuoancy, 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 Stor es . ' ..... ~ ~' / ~¢ 9. bize of lot: Front .......... ,,/,..7,~., .................. Rear ...........~.,.,.~.. ..................... Depth Date ....... of Former Owner 1 1. Zone or use district in which premises are situated .......... !~Z~." 12. Does proposed construction violate any zoning ~aw, ordinance or regulation: ....../~...0.... 13. Will lot be regraded ..... ./~.....O.. ..................... Will excess fill be removed ~remises: [ ] 14. Name of Owner of premises ...'~.g.'..~..~.....~.(-~3..~.~..~..~...~.:....//...(:.~.. Name of Architect (Address) Name of Contractor ... (Address) No.) No.) hone No.) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-ha property lines. Give street and block number or description according to deed, and show street names er interior or corner lot. dimensi e wheth- STATE OF NEW YORK, ,, .,~' ~ ) ,~, (.~...~.~.,-,.~,-~ ' .~.~.~.¢Z.;~.'~ be.rig duly sworn, deposes and says that he iS the a , .:: ....... ======================== ....... :.:: ........................................................................................ [Contractor, agent, corporate officer, etc. J of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file tf statements contained in this application are true to the best of his knowledge and belief; and that the work will be pm set forth in the application filed therewith. ...................................... day of .................................................. 19 ............. )licant abov .~ named. applicatio that all )rmed in manner Notary Public ...................................................................... County ~ applican t) / {Cbntractor, agent, cor/)orate officer, etc.) · of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file : that all statements contained i~ this app[icatio~ are true to the best of his knowledge and belief; and that the work will be F srformed in the manner set forth in the application filed therewith. day of .................................................. 19 ............. %blic County ............................ Notary ~' , ~ ............. -i