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Home My WebLink About9037-z FORM NO. 2 TOWN CLERK'S OFFICE SOUTNOLD, N. Y. BUILDING PERMIT (THIS. PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9037 Z Permission is hereby granted to: Ge ,~.~ ~ .....5~,:~ ~k ................................................. ................... ~.¢~r.th...~,~Y:.view...a~a~ ......... ~outho~d ~o ..~.~.J...1.~ ....~ .n..~ .c..¢..e.:~.~,.q.V.~...b.~ ~..~:~. ~g...¢~.. ~:e~.e ........................................................................ at premises located at .....bf.~'. ...... J~D,~.~,.~.~'...~,J~'.~'..~,~Ct, ........................................................... ............................................... D.~ttho.1 ~l ....... ~.,.Y~ ............................................................................. pursuant to application dated ........................?..e...~. ........ ~.. ............... , 19...~.., and approved by [he Building Inspector. ~0 Fee $..~, ~., .............. Building Inspector TOWN OF SOUTHOLD Building Inspector's Office Town Clerk Eluilding -/ x, ,x' TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. £xomined ........ ~..~...~. ...... .2 ............, r~ ~proved .............~ .......... '.(. ............ , 19..~.;... Permit No..~.~..~..~...~ ........... APPLICATION FOR BUILDING PERMIT Dote .................... .................. , INSTRUCTIONS a. This application must be completely filled in by typewriter o¢ in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on 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 will issue a Building Permit to the applicant. Such permit 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 Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of o 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, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) .................. ~ '~ ~"~7, ,'~Addr~s, oj~gpplicant), ~ ............. State whether applicant is owner, I~s.see,.age. nt, architect, engineer, general contractor, electrician, plumber or builder. . If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ........... ~....~.~~,.....T;... Plumber's License No ................................................. Electrician's License No ............................................. Other Trode's License No ............................................... Mo o 78 74' Location of land on which proposed work ~1 be done. p~ r~ ........... .~.;..~. ............Lot No ......... '.~ .......... Street and Number ....... .~;~.~....~....~.~..~.~z~'~.'~.~.....~../..'~.. ...... ...~...~~ ...................................... Municipality State existing use and occupancy of premises/crud' intended use aIad occu~u~p?ncy of proposed construction: b. Intended use and occupancy ............................................ .~...'.:r. ...... ../..~..~....~.~..~ .................................... 3. Nature of work (check which applicable): New Building'. ................. Addition ..... _~ ....... Alteration ............... Repair .................. Removal .................. Demolition .................... Other Work .~J..:.t..~...%.~..~. .............................. (Description) (t~ be paid on filing this application) b. If clwelHng, number o~ dwelling arfits ............................ 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 ...... Z ........... Number of S~ories ....... ~...~ .................................... : .............................................................. Size of lot: Front .............. ''Z.).~..; ............................... ........... ...................... Depth ...... . ............. Date of Purchase .............. /~.~.Z .............................. Name of Former Owner ..~....~~ ............ Zone or use district in which premises are situated .................................................................................................... Does proposed construction violate any zoning Iow, ordinance or regulation: ..... .(~.~ ........................................... Will lot be regroded ......... /~...~ ...... W[II e~ss fill be removed from premises: ( ) Yes ( ~No ~ome o{ Architect .............................................................. Address ................................ ~hon* ~o ....................... ~ome of Controctor ............................................................ Addross ................................ Phono ~o ....................... 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 whether interior or corner lot. STATE OF NEW YOR](, ~ ~, ~ .............................. ~..7..~.~..~~ ........... boin~ duiv sworn, doposos ~nd soys that he is the (~ome of individual sionin~ obovo nomod. He is the ................................................................................................................................................................................. (Controctor, o~ont, corpor*to officer~ etc.) of soid owner or owners, ond is duly outhorized to perform or h~vo performed the soid work and to moke ond file this opplic~tion; thor oll statements cont, ined in this ~pplicotion oro truo to tho~best o{ his knowle~Oo ond belie~i end thor tho work will be per{ormod in the marmot set fo~h in the op~licotion filed thorowith. Sworn to boforo me this 9. 10. 11. 12.. 13. 14.