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Home My WebLink About7662-z FO~M 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? 7662 Z Permission is hereby granted to: Theo ~ittner ....... ~.~..~ .............................................. ................. ~o~th~l~ .................. : ........................ to ,..e ~'~e c.$.. and...~t ai~...femtc&n~j ....... ~.. ~d4e~.-.Lake..,R-!-¢% .~.. Se~Ol .) ................ at premises located at ..[~/.$..~-J.4~[.~e-..~..-.-.(C]~F.).--~ .................................................... ~. .......... pursuant to application dated ............................. .~_~.~......t~. ......... , 19.~...)}..i., and approved by the Building Inspector. Fee $..'J5 *.g~) ........... FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .......................... p. ........... 19. proved ................. l .......... , ....... , ,9. Disopproved ale ..........~¢ ..................... i ........... ...................... Application No ......... Date /' ~///~::) ~ 9.~.,~:...... INSTRUCTIONS a. This application must be completely filled in by typewriter or~ in ink and submitted in triplicate to the BuiJding Inspector, 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 adjoining premises or public streets or areas, and giving a detailed description of layout ofproperty must be drawn on the 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 will issue a Building Permit to the applicant. Such permlt'~ shall be kept on the premises 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 O~¢upancy 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~L3 Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances ec~r Regulations, for the construction of buildings, additions or alterations, or f~)r removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, end regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a c~rpor t~n) ~ .................. ....................... (Address o~ appricant) ........ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..... ~ ................................................................ If applicant is a corporate, signature.of ,duty authorized officer. ~,J~me and title of c~'po~te 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.: ........................................Lot No ......................... Street and Number Municipality 2. State existing use and occupancy of premises and intended us/9 .and occupancy of proposed construction: a. Exisiting use and occupancy ......... :~..~~)......C~.....~~~ .......................... b. Intended use and occupancy ~..~ 3. Nature of work (check which appHcabb): New Building~· ........... ~ ..... Addition .................. Alteration ................ Repair .................. Removal .................. Demolitior ..................... Other Work. (Desc riptlon)(.,/ 4. [stimated Cos ...... Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwollino units ............................ ~umber of dwellin~ units on oath floor ............................ ff ~ro~e, number of c~rs ............................................................................................................................................. 6. I{ businoss, commorci~l or mixed occupancy, specify n~ture nnd extant of o~ch type o{ uso ............................ 7. Dimensions of exi~tinfl structures, ff any: Front ............................ Rear ................................Depth .................... Heioht ........................ ~umber o{ Stories ................................................................................................................. Dimensions of some structure with alterations or additions: Front .................................... Rear ............................ Depth ................................Height ............................ Number of Stories ................................ 8. Dimensions of entiro now construction: Front .................................... Rear ............................ Dopth ........................ Height .................... Number o{ Stories ..................................................................................................................... 9. Si~e o{ lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date o~ Purchase ........................................................~ome o{ Former Owner ........................................................ 1 1. Zono or uso district in which premises ~re situatod ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .......................... ~ ..................... 13. Will ~ot be regraded . ......................... Will exes fill be removed from premises: ( )~es ( ) No 14. Name of Owner of premises .,--.,__~Addre ne No~q.~.,~~ ~ 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. ,~b'r?~-~0~ - ,- .......... b ly sworn, deposes and soys that he is the applicam obovenamed. ~~ %" ~- , He ~s the .......................................... ~ ...................... ~ ............ ~4; .............................................................................. ~Contra~ ~~er, etc.) of said owner or owners and is duly outh~er~m~ p~ t~e said work and to make and file this application; that oil statements conto~~~~f his knowledge and belief; and tho~ the work will be performed in the manner set fo~h in~~ ~li~t~r~~ Sworn to before me this ~ ~ _ ~ _ ~ ~ ,~ ~ .................. ot ............ ................ , w-.p/ X .... ............ ............. ..................... [ ~ -/~ // (Signature ~pplicont)