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Home My WebLink About7592-z FORM 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) N? 7592 Z Permission is hereby granted to: ..~x,/.~.~../..:~.......~../,<,./.~ ....... .7...~.:.~...~:.~.~.,~...:~......~.. .~....- ..... .......... ~.~.:~. .~..~.~. ./~..:~......~..,. . ~o ..:~:...:........~:..~......-.. ....... ~.~..: :.....~..,.~..~.....:.~.~..~.>... ............ .f. . '.~ ~.:~. . ~. . ~. ......... ~. . .~ ~. . . . . . ~ ~:. :. ~ '.~. . .~.~:. . . ,~>~,~. . . . . ~. . .~. . . . . .~f~f , ot pre,,~es 'o~oted o' ......... .2~.~......~;..~.~'~...2:.~....~.~..'.......:~'~"/.'"" ..... Building Inspector. FO~M NOo 1 TOWN O~ $OVTNOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ,/~)/~.~ -- '7/SOUTHOLD' N' Y' Examined ........................................ , 19../. ..... Approved .............................. ::"z:"_'-'~ 19 ........ Permit No./ .................................... Disapproved o/c ...... ...-,.__ ................. ~ ....... .,7. ........................... ................................................................... .............. : ............... .............. ........................................ (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building~ Inspeetor, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adioining premises or public streets areas, and giving a detailed description of layout ofproperty must be drown On the diagram which is pad- 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 will issue a Building Permit to the applicant. Such permit shall be kept on the premises availoble for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Ced-ificote of Occupancy shall have been granted by the Building Inspector. APPLICATION 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 alterations, 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 authorized inspectors on premises and in buildings for necessary inspections. 70 ~.Signoture of '~licont, or nome, f a corporatzon) (Address of applicant) ' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~..//¢¢g ,£ ~: ...................................................................... '/... Name of owner of premises ..... ~1 ....... ,r, ~ ............................................................................ 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 License No ............................................... 1. Location of land on wh ch proposed work w Jif be done M~p No Street and Numbe,/..r~-.~..',~4~x'~,~.',P~?~-~Z.~-,m:'-4~'~¢.7. "/~/'~7~.~ ............. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed ~:onstruction: o. Exisiting use and occupancy ......... ~.~'~/~. ...... ¢./,4¢? .... ~Lx~ ..................................... b. Intended use and occupancy ............................................................................................ .~z/..~,~Z. Tc~.~ ...... 3. Nature of work (check which applicable): New Building,. ................. Addition .................. Alteration ................. Repair .................. Removal .................. Demolition .......... .~..~.,~r Work .~.~z.~..c../t~'.~",(/.Z.,...~.~..,~.~r;..~, .~/ /,~,J ~ ' (Description) 4. Estimated Cost ..........?..~'..,,~.',,~ .................................. 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, spec'~"h-ature 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: Fro/~t .................................... Rear ............................ Dept~p~Zfl...~,.~, ......... Height .................... Nu~b~J c~ Stor~s~:/. ................................ /...~..C/.. :.....~.../.· ........................... ~..~.~.~..,~..;~. ....... 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 ..................................................................................................... i2. Does proposed construction violate any zoning law, ordinance or regulation: .,,~.~ ............................................ 13. Will lot be regraded . ........................... Will excess fill be removed from premises: ( ) Yes ( ) No 14. Nome of Owner of premises .................................................... Address ................................ Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly oll buildings, whether existing or proposed, and indicate all set-bock from indicate whetherPr°perty interiorlines' GiVeor cornerStreetlot.and block number~ scrip~tio~?.)according~:, to deed, and show street names STATE OF NE.'C~YOR~,/,~ ~, ~ I c c COUNTY ~~f o.. ................................................................................................. being duly sworn, deposes and soys that he is the opplicam (Nome of individual signing controcf) above named. He is 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 contained in this application are true to the best of his knowledge and belief; and thor the work will be performed in the manner set forth in the application filed therewith. Swo~r,~,~o~_,,~e me t h is ~ , ..... n / O n/f).< Nota ........... .....................