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Home My WebLink About7460-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? 7460 Z Permission is hereby grc~nted to: ./.:.55.T.~:..~!.!?.. ......... (:!.~.:.~..~.5_.. ...... ~'...~ ..... ~......L~..~.:?::.:: ......... ~..~.~...: ~ ~/ at premises located .................................................................. [ .......................................................... ........................................ 4j...>~.Z ......... L!~.~.'/.~:..!..o....~/. ................................ pursuant ,o application dated ................................. D.......zO....~..~.~..., lY../,.., approved by Building Inspector. · ~ ,./.5. ................ Building Inspector ~0~ NO. I TOWN OF $OUTHOLDi BUILDING DEPARTMEN~T TOWN CLERK'S OFFIC~ SOUTHOLD, N. Y. Examined ..................... ~.-...~..~.,.~.~ 19..~....~/. Application No ..... Z. ,L~...~...~ .......... Approved .................... , 19Z~.. Permit No. :Z./~....~../...~ ....... Disapproved o/c ................. ).............._~ (Building Inspector) APPLICATION FOR BUILDING pERMIT Dote ........................................................ INSTRUCTIONS ' ' a. This application must be completely filled in by typewriter o¢ in :4nk and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee occordingito schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets o~ areas, end giving o 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 befoJ'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 wo~k. e. No building shall be occupied or used in whole or in part for any p~rpose whatever until (3 Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for th~ issuance of (3 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, os 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 end in, buildings for necessary inspections. .... ........ ......................... (Signature of applicant, or name, if o corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, gene~ral contractor, electrician, plumber or builder. ........ ........................................................................................ ........................................................................... Name of owner of premises ...~..':~..~?.....~....~'~.~r~ .~.. ....... ~ ........................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and tide 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 which pr~oposed work will be done. Map No.: .... ..................................... Lot No ......................... Street and Number....... "--- ............................. ..... Municipality State existing use and occupancy of premises and intended use an~J occupancy of proposed construction: a. Exisiting use and occupancy ......... .~,,¢. .......... [~. .......... : .......................................................................... 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 ............... .~.)...O...O..~.~.O...O. .................... Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units .......... Z ............. 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 .......... ]~Z~. .......... 7. Dimensions of existing structures, if any: Front ............ ~....~.. ...... Rear .......... w~..~. ............. Depth .~.....~..~ ........ Height ........ ,~..'..~'... ...... Number of Stories .................. ~ ........................................................................................... Dimensions of same structure with alteretion~,additions: Front .......... ~'.~... .................. Rear ...~.~R. ............... Depth ....... '~...~.. .............. Height ........... .~../ ........... Number of Stories ....... ~... .................... 8. Dimensions of entire new construction: Front ............ c~....~,. ............... Rear ...... ~..G~. ............. Depth ....~.~..~ ...... Height .....~.../~...../. ..... Number of Stories .............. 9. Size of lot: Front ............ ./...~....O..:.~..~ ........................ Rear ............. ~....O.....~....~.~. ....... ~th ...ZZ~..<..~...~......~.~ 10. Date of Purchase .............. ./d...~....~...~.. ........................ Name of Former Owner ................... ]:~ ............... / ............... 11. Zone or use district in which premises are situated .......... ,~.~....~.~../..~..,~'.~...~.....'~.. ..................................................... 12. Does proposed constructioryviolate any zoning law, ordinance or regulation: ........ .~.~..f,-~..~ ......................... 13. Will lot be regraded ....../?,,J...~....: ........ ~Vv'~I excess fill be removed from premises: .,( ~.Y~s ( )No 14. Name of Owner of premises ..~.'~.~.~...~....~..~...~...... Addre~~.~..~-~....~.:..}~'Phone No ....................... ..... Phone No ....................... Name of Architect ........................... ~ .................................. Address ................... ~ No..~.~......~.~..~ Name of Contract~~i~.....~..~.: ....... AddreSS....~..~. ......... Phone PLOT DIAGRAM LocQte cl,[arly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions from property lines Give street and block number or description according to deed, and show street names and indicate whether interk r or corner lot. STATE OF NEW YORK, ~ S S COUNTY OF ................................ ~ ' ................ ~...~..../.~..~...-.C!...'........~../..~....~ ....... .~ ...... being duly sworn, deposes and says that he is the applicam (Name of individual signing contract) a b ow,~ named. He is the ................................................................................................................................................................................. (~m~lu,, agent, corporate officer, otc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make end file this application; that all statements contained 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 therewith. Sworn ]~o before me this ....... f~../'~ day of ..~z~..~ .......... , 19 .-~....~.' Notary Public, ..~'.~~ .............. Cojm'j~ ......... ...'~........~...~......,,~...;.,,,C/~_,~_,~ ............... ~~--~-~'~.,~x.~ (Signature or applicant)