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Home My WebLink About7120-z FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENTi TOWN CLERK'S OFFICE SOUTHOLD, N~. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ~? 7120 Z C Permission is hereby granted to: .~..'...::.,. ....... C~.?..~:~.!~C....C~.f.?/..r.. ~ ....... Cfi.~ ~ .... :...~.~.,.,.~ ........... ~..cr'~ .......... ~.~.~-~...z. ~r,~ to ...~.~..&C..T. ....... ~ ....... ~ ........ ~L~.C.~ ........ at premises located at ........... .'~'..~... ..................................... ......................................................... ......................................................................... l.?... ~...~:.~...-c..~.~...~. ......... .A.t.:.?,( .............................. pursuant to application dated ................................... ./....~....~!.~.~.., lC~..~...., and approved by the Building Inspector. Fee ....................... Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT Examined ................... ~ .................... 19,...)... Z Application No. .?. /../~ ,.~ ]97'/,~ ~7 / :~ '> I' _ ' ............................... Approved ........................................ , ... ..... Permit No ..................................... Disapproved a/c ......... .i...~i:?~ ............... ~,~..~ ........................................ ...................................................................... :.//:~ ............................ ~ ............... (Building Inspector) APPUCATION FOR BUlL, DInG P~RMIT ~'~ Date /' , INSTRUCTIONS a. This application must be completely filled in by typewriter oe in ih,k 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 lot and of buildings on premises, relat onship to adjoining premises or public streets o~ areas, and giving a detailed description of layout ofproperty must be drawn ~n 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 wit} issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the wor~. 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, Ordinances or Regulations, for the construction of buildings, additions or alterations,or {or removal or demolition, as herein described. The applicant agrees to comply with ail applicable laws, ordinances, bu Id i~g code, housing code, and regulations, and to admit authorized inspectors on premises and in, buildings for necessary in~vpections. (Signatur~ of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .................................................................................................................................................... If app{icant 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 .............................................. Location of land on which proposed work ~vill be done. M~p No.: ..... . ................................... Lot No ......................... Street and Number .: ........ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ............................ i...';......,'.~,..>..~.....~i~..~. ..................................................................... b. Intended use and occupancy .................................................................................................................... 3. Nature o~,.~work (check which applicable): New Building .................. Addition .................. Alteration. ................. .~ ~ ' ' ~ -., :, ~'~ / 4 t~ " Repair ....... ~, .......... Removal Demolition .................... Other Work /~ ~ ,\ (Description) 4. Estimated Cost ..................... :3.'...~?..~.:....(?...?. ................. Fee .................. ./..~.i.....~...L~. ...................................................... (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 ................................................................................................................. Dimensians 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 ...............D..). ................................... Rear ............ ~'}i~ ........................ Depth ...... .~...L)..J.~ ................. 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use djstric~,i~ which"l~mises are situated ..................................................................................................... 12.' Does pFopased construgtion violate~,any zoning !l?w, ordinance or regulation: ........................................................ 13.~ 'V~iI lot be regraded'. ........................... Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises ,,z.,.t..~..,.~.~.l:.~h.../.~:.,,/.,~.~..,..~ ......... Address/,...~.~'...~hcY...4..~.~....:. Phone No;~ :;.~..'.;:..',~..~...~.. Name of ArchiteCt .............................................................. Address ................................ Phone No ....................... Name of Contractgr (....::;~: ................................................... Address ................................ Phone No ....................... ,' j t 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 ~/hether interior or corner lot. STA'TE OF NEW,YOI~K~c COUNTY OF ..::~.~...:.:..~:?....] ...... ................................................................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) a'bow~ named. He is the .................. '...,,rJ~f..;~.,~¢:':¢:'~' ................................................................................ .... .. .................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to ~ke and file this application; that aH 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 forth in the application filed therewith. Sworn to befor~ me this .~ ~ , ~ ~'~ ,:., . .............. x:..... ........ ...... ........ ............... ...... ........... , ............ (~i~t~r~ ~J ~lica~t)