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HomeMy WebLinkAbout7102-z FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENt' TOWN GLERK'S OFFICE SOUTH'OLD, N:. Y. BUILDING PERMIT ~ (THIS PERMIT MUST BE KEPT ON THE PREMISES COMPLETION OF THE WORK AUTHORIZED) UNTIL FULL N°. 7102 Z Dote ........ : ............ ~ftrtlJ~. ......... .~. ...... , 19.~... Permission is hereby granted to: 0.~ ~.g~..P. emis .................................................... ......... 2.9.0% ...... .~4az',~mee .~..A.v~ ........................ .................. .G~.~.~.f; ....................................... to .,~;~.e.¢~ .t...a~d.. ~ir~tain.. £enc e...&...h.e, cl, ge... ~ ..................................... : .................. at premises located at .~.ri~.~n.~.t~..k~.e ................................................................................. ~ .......... ......................................... .~r.~o~p.o.~ ......... ~.~Y. ......................................................................... 19...~..,., and approved by,the pursuant to application dated .................... ......... ?-.-..,,--.---, Building Inspector. Fee $!.~..'...°.Q ............. Approved .................... FOI~M NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMEN~ TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Permit No ...................... ~ D sapproved a/c ,<.-:.~ ,~-~"x ~ APPLICATION FOR BUILDING I~ERMIT INSTRUCTIONS / a. This application must be completely filled in by typewriter or. in ihk and submitted in triplicate to the BulldOg Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according t~b schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets areas, and giving a detailed description of layout ofproperty must be drawn qn the diagram which is part of this applicatipnf c. The work covered by this application may not be commenced befor~ issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue ~ Building Permit to the applicant. Such per~"i~ shall be kept on the premises available for inspection throughout the worE. 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 York, and other applicable Laws, Ordnances or Regulations, for the construction of buildings, additions or alterations, or (or removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, buildihg code, housing code, and regulations, and to admit authorized inspectors on premises and in, buildings for necessary inspections. (Signatur~ of ~plicant, or name, if a corporation) ..... (Address at applicant) State whether applicant is~_,owner, lessee, agent, architect, engineer, genera~l contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer. (Name end title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Zrade's License No ............................................... 1. Locat on of and on wh ch proposal work w be d~ne Map No.L~. : ~ .................... Lot No...'~,~ ................. Municipality 2. State existing use and occupancy of prem~es and in!cnded use arTtfiP;occupancy of proposed construction: Exisiting 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ~t~..~ .................. ~- C~o (Description) I 4. Estimated Cast ............................................................ 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 .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................... 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 ..................................................................................................... 12. Does proposed construction violate any zoning Iow, ordinance or regulation: ........................................................ 13. Will lot be regraded ............................ Wilt,e.~xcess fill be removed from~emises: ( ) Yes ( ) No 14. Name of Owner of premises., ..~ ......... Address~. .......................... Address ................................ Phone No ....................... Name of Architect ....... ...~. .~--_._____ Name of Contractor ...~/~.~.~ ............. Address~Pj...~~Phonee No. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-~ck dimensions from property lines. Give street and block number or description according to deed, and street names and indicate whether interior or corner lot. ~, ~ COUNTY OF ~~=.....~ b~ , ............................ ~~~;~ ................... being duly sworn, deposes a~s that he is the aDp[icom (Nam~ bf ifidividu~/ signing contracf) above named. ~ ~ ~ ~,~,.~ ~ ~' ~., ,ho ................... C~¢~..Z. '~.~.~ ....................... .~.~.Z .................. (ConLractor, 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 that the work will be performed in the manner set fo~h in the application filed therewith. 7.. :. T 7 .......... ........................... ................................................... ...... .............................