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Home My WebLink About7278-z FORM NO. 2 TOWN O~ $OUT~OLD ~ BUILDING DEPARTMEN~ TOWN CLERK'S OFFICE' SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7278 Z Dote .. : ........ , ] .. / PermJ,,ion ,$ hereby granted to,~ ? ! ~ / / ~~.,~,,~,~,,..~,,,cc,..~ ' / ........... .... ...... ....... ...... ~.. .............................................. ..... : ........ ............. ~. ...................... ~t premises ~~..~.....~.....~~.~.~ ....................................................................... ~~~~ ................................... pursuont to opplicotion d~ted ...................... , 19 ond opproved by the ~ ,/~ ..... I;'OI~M NO. 1 TOWN OF SOUTHOLD i BUILDINI~ DFPARTMENT TOWN CLERK'S OFFICEi SOUTHOLD, N. Y. ...... .......... Disapproved a/c ......................................... (~./.. ....................................... .............................................................. APPLICATION FOR BUILDING ~ERMIT Date ............... INSTRUCTIONS a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according }o schedule. b. Plot plan showing location of'iot 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 ~n the diagram which is part of this appJication. c. The work covered by this application may not be commenced befor~e 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 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. 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 iYork, 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 oil applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in, buildings for necessary iqspectlons. .... ......... (Signatul~e of applicant, or name, if a corporation) . State whether applicant is owner, lessee, agent, architect, engineer, general contractgr, electrician, plumber or builder. Name of owner of premises ......~.ft~.~.,...~......./.-~./~..,...~.~ ........ : .......................................................................... - 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 L~cense No ................................................ ' Location of land on whic~ p/repose/c/w~, will bede. Map No~..~..' Lot. ~ ............... Street and Number ~:~'/~../.,-~-~,ffl,~2~.........~ .................. ;. ........................................ ~ ~ C)' c7) X,/ ('/~_~/,,~J '] Muni~pdlity b. Intended use and occupancy ...................................................... ! ............................. 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................... Other Work .............. ~ ....................................... (Description) 4. Estimated Cost ................. i .......................................... 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 ................................... i'Rear ............................ Depth ........................ Height .................... Number of Stories ..................................................................................................................... 9. Size of lot: Front ................Lt/.~.-: .............................. Rear ........................ ~ ................. Depth ...../.../~..~.~. ................. 10. Date of Purchase ....... : ................................................ Nome of Former Owner ........................................................ 1 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 . ........................... Will excess fill be removed ~rom premises: ( ),,Yes ( ) No 14. Name 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 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. , z'. STATE OF NEW YORK, COUNTY OF .......... ~...:..';,...';~ ........ .......................................... be ng duly sworn, (Name of individual signing contracf) above named. ,j dep~se~s ana says that he ~s the applicant He is the ................................................................................................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perfor~m or have performed the said work and to make and file this application; that all statements conto:ined 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. Sworn:~ i~~~t° ~b,~e me this - .......... ~...~. .... f ...............................,19,~ ~~~~ ~~(~'~' ~ JUDITH T BOKEN ,/ '~': ./~.- Notary Pubiic, Stat~ of New York No. 52-0344963 Suffolk Count~( Commission Expires March 30, ~9~~