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Home My WebLink About8865-z FORM NO. 2 TOWlq OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, Iq.. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.o 8865 Z ~ Pormission is hereby granted to: qp..z.~,e...Z..Z.....c..9.~,.~..¢.~.:...~..o.~. ..... ~..q...~..~..~...?,.~n Bou~§onct~ ............... ~o~tha~u~. ............................................. premises located at ..... ~"}~a:~"~O&~ .................................................................................... ,'" ................................................. ,.~,~,~.~.~:....~...~,. .............................................................................. ~,~-,~"'~:-~ 'i Pt,t~ont to application datecJ ........................... ~e]p~,. ....... ~ ...... , i9.~.., and app~ed by the : Building I~tor. ~J TOW~ OF SOUTNOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, H. Y. Examined ........................................ , 19 ........ Approved ........................................ , 19 ........ Permit No ..................................... DIsopprov,ed a/c ............................................................................................ Application No ............................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a This application must be completely fdled in by typewriter 0¢ in ink and submitted in triplicate to the Buildir Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buddings on premises, relationship to adjoining premises or public streets ~ areas, and giving a detailed description of layout ofproperty must be drawn on the d~agram which ~s part of th~s apphcatio[ 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 wdl issue a Building Permit to the applicant Such perm shall be kept on the premises available for inspection throughout the work. e. No budding shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupan, 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 tk Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances, Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe, The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, <3nd regulations, and t admit aulhorized inspectors on premises and iN buildings for necessary inspections. (Signature of applicant, or name, it a corporation) (Address of applicant) State whether applicant ~s owner, lessee, agent, arch~tecf, engineer, general contractor, electrician, plumber or budde ....................................................... b~;;:.:.~.~..,.;~ ...................................................................................................................... Name of owner of premises .......... ~...¥-~qt---J~<~'.,~o-z.~.h~--~ .......................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's L~cense No ................................................. Electrician's License No ............................................. Other Trade's L~cense No ............................................... 1 Location of land on which proposed work will be done. Map No ........ .~.:~ .................... Lot No ......... :¢.3~ ......... Street and Number ..~./ ....... ~"~:.'~'"',~' ~' ,"t' '~'"?~'~'~"~'¢J' ........................................................... '/V(;~f~i~;ii;~ ...... 2 State existing use and occupancy of premises and intended use and occupancy of proposed construction: a Exisiting use and occupancy · ..~; ~-i,.,.':.,.:L.~-.:~ g -.]...;:'O.,.t.-t.>:',...e...t.,,-~, ............. 'u"': ...... c,~' ............................ b. Intended use and occupancy ...... ~ ........... .'~-¥~,'-.. ~"~-":bt'J--;-"~"3:"~'q,.',L.~',;':~'z','~- 3 Nature of work (check which applicable). New Building ....X.,K,lf ....... Addition ................. Alteration ............ Repair .............. Removal ............... Demolit~or. ...............Other Work ............................................... (Descriphon) · ~ Estimated Cost .................... ,~..O.~...C.t.O...O...~ ................ Fee ..I~.~z'.Q ..................................................................... (to be pared on filing th~s application) 5. If dwelling, number of dwelhng units ...~ ................... Number of dwelhng 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 .................................................................................................... D~mensions of same structure with alterations or addmons: Front .................................... Rear ................... Depth ................................ Hemght .......................... Number of Stories ............................ 8 Dimensions of entire new constructmon: Front .......... Z.00 ................... Rear ...... ~.gO ............... Depth ...p}+ ........... Height .................. Number of Stories .............Ori~ ............................................................ 9. Size of lot. Front ...... ~..g.Z.L'Z,~::' ................................. Rear ......................................... Depth .......................... 10. Date of Purchase ....................................................... Name of Former Owner ...................................................... 11 Zone or use district in which premises are s~tuated ...... ;:~"JJ'"'"-~-t, ............................................................... 12 Does proposed construction violate any zoning law, ordinance or regulation ........ ~:e ......................................... 13 Wdl lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises ...~....~,...,>...¥e,.~:..:..~:~,=?o~...~.t~ddress ....:"~"c?'t~:~' ........... Phone No ...................... Name of Architect ......................................................... Address ................................ Phone No ...................... Na~e of Contractor ..... ~.,*~"?~"::"::-'""~:~l~e% ............. Address .......... :t;'c~,~z'r-q'~' .... Phone No ...................... PLOT DIAGRAM Locate clearly and dzst~nctly all buddings, whether ex~shng or proposed, and indicate all set-back d~mens~ons flor property lines Gwe street and block number or description according to deed, and show street names and ind~cat whether interior or corner lot STATE OF NEW YORK, S S COUNTY OF ....31, ~%:~Z.]r_; ............ f / , . ~ ............................................................................................ being duly sworn, deposes and says that he ~s the apphca, (Name of individual signing contracf) above named. He ~s the ............. O~Zt~'z":~a,~ ................................................................................................................................. (Contractor, agent, corporate officer, etc ) of sa~d owner or owners, and ~s duly authorized to perform or have performed the sa~d work and to make and f~ this applicatton, that all statements contmned m th~s apphcat~on are true to the best of his knowledge and behef; a~ that the work wdl be performed m the manner set fo~h in the apphcation filed therewith. Sworn to before me th,s .................. -j.?. day of ........ ~. ........ :~,m4' ......... , 19. Notary Pubhc, . ................... ~...:i~./~. ...... County (Signature of applicant)