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Home My WebLink About8812-z FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, bi. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLEYION OF THE WORK AUTHORIZED) 8812 Z Permission is hereby gmpted to: NOTIFY BUILDING DEPARTM, r,~[ 765-2660 9AM TO ~PM FO~ ED INSPECTIONS: 1 BEFORE BACKFILLING TION OR $TA~T FRAMING ~. BEFORE COVERING PIPELINE 3. FINAL WHEN JOB COMFLETED NOT RESPONSIBLE FOR DESIGN TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ........................................ , 19 ........ proved ...................... ,9¥..>... P, rm,t,o .......... .... Disapproved a/c ..................... ~ ...... ..... ......... ~. .......................... Application No ................................ APPLICATION FOR BUILDING PERMIT Dot e_~~'~ ......... ~?.....~-~ ] 9..,,?~, INSTRUCTIONS a. Th~s application must be completely filled Jn by typewriter or ,n ink and subm,tted in triplicate to the Buildin. Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan show,ng location of lot and of buildings on premises, relationship to adjoining premises or public streets o areas, and giving a detailed description of layout of property must be drawn on the diagram which ~s part of this application c. The work covered by this apphcation may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector wdl ~ssue a Building Permit to the applicant. Such permi 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 Occupanc; shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the ~ssuance of a Building Permit pursuant to Building Zone Ordinance of the Town of Southotd, Suffolk County, New York, and other applicable Laws, Ordinances o Regulations, for the construction of buildings, additions or alterahons, or for removal or demohtion, as herein described The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and t, admit authorized inspectors on premises and in buildings for necessary inspections. applicant, or_name, if a corporation) (Address of applicant) ~ State w~ether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of If applicant is a corporate, mgnature of duly authorized officer. (Name and title of corporate officer) Builder's L~cense No ..................................................... Plumber's License No ......................... : ....................... Electrician's License No .................... : ........................ Other Trade's License No ............................................... ~ 1 Location of land on which prop,.qsed work will be don9. ~Aap N~ot No ...... .,~....~.. ~ Municipality 2. Sta~e existing use and occupancy of premmes and intended use and occupancy of proposed construction: a Exislting use and occupancy .........................../..../.~. ...... ~ ................................................................ b. Intended use and occupancy ............... ~ ..... -- ~ ..... ..~....~...~.. .................................................................. 3 Nature of work (check which apphcable). New BuilrJmg .................. Addition .~ ...... Alteration ..... Repmr .............. Removal ............... Demoht~or.. Other Work ....................................... (to be paid on fihng this opphcation) 5 If dwelhng, number of dwelling units ........... ~.. ............ Number of dwelhng umts on each floor .......................... If garage, number of cars ....................... 6 If business, commercial or m~xed occupancy, spec~fy~. ,nature and extent of~_,each type of use ....................... 7 D,mens,ons of exist,rig structures, if any Front ...... .,~..~..: .......... Rear ........... ~.....~....'. ........ upnne t' ......... Height ........................ Number of Ston~s ...... ./. ........................................................................................ Dimensions of some~structure with alterations or addmons' Front ............... .~._a. .............. Rear ........ ...~'...~. ........ Depth ................ ~.... ......... Height ......................... Number of Stones ............. .~...5 ........... 8 D~menslons of ent,re new construction: Front ............ .~..~..," ............. Rear .......... .z~.....~. .......... Depth ....... ? "~ Height ................. Number of Stories .............. ~ ................................................ 10. Datc of Purchase ~ii~ii~i?'i~.~'.~i."i i] ii i]iii'Name of Former Owner ~ I I. Zone or use district m which premises are situated ...................................................................................... 12 Does proposed construction violate any zoning law, ordinance or regulation ......¢~.~....~ ...................................... 13 Wdl lot be regraded ...~ ............. WHI excess~fill be removed from premises: (). Yes (~?-) No Name o~ Arc itect ............................................. Address ................................ Phone No ................ Nome of Contractor ....................................... Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ex~sting or proposed, and red,cate afl set-back dimensions frorn property hnes Gwe street and block number or description according to deed, and show street names and indicate whether interior or corner lot STATE OF NEW y~Rlc~',,/~ COUNTY OF ...~~,-,. ..... ............... ..~..~_ ~./..~.......~...~.~.......~..~..C....../~.. ........................ be,rig duly sworn, deposes and says that he ,s the applicam (Name of md~wdual signing contrac~ above named He ,s the .................... ~.~.~.~..(~ .................................................................................................................. (Contractor, agent, corporate officer, etc ) of sa~d owner or owners, and is duly authonzed to perform or have performed the sa~d work and to make and ill, this application; that ail statements contained m th~s apphcation are true to the best of his knowledge and behef; an~ that the work wdl be performed ~n the manner set fo~h Jn the apphcation filed therewith Sworn to before me th~s .................. ~day of ............................... ~..., 19 .. Nato Pu c. __ ~ bo I:,- a , .... ....... ,t,OITH T , , State ~ ,C~, SuI~o~R County Cgl,~rr,,sston