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Home My WebLink About8379-z FO'l~.~r NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT 'TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 8379 Z Dote .......................... ~ ........ t~- .......... , ] 9..~.~. Permission is hereby granted to: ................... F~s..I~ ........................ at premises located at .................................................... ~.~ex s...l;e~l.a~t ............................................................ :~. ............ Building Inspector ,I ./ _/ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Disapproved o/c ..................................................................................... APPLICATION FOR BUILDING PERMIT Date ........ ~(...?...: ............................... 19...~..~... INSTRUCTIONS a. This application must be completely filled in by typewriter or m ink and submitted in duplicate to the Buildif Inspector· b. Plot plan showing location of lot and of buddings on premises, relationship to adjoining premises or public stree or areas, and giving a detailed description of layout of property must be drawn on the diagram which ~s part of th~s Iocaho c. The work covered by this apphcation may not be commenced before issuance of Budding Permit. d Upon approval of th~s application, the Building Inspector wdl ~ssue a Building Permit to the applicant Sbt permit shall be kept on the premises available for inspection throughout the progress of the work. e No building shall be occupied or used in whole or in part for any purpose whatever untd a Certificate of Occupan, shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuanoe of a Building Permit pursuant to tl Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buddings, additions or alterations, or for removal or demolmon, as herren describe The applicant agrees to comply with all applicable laws, ordinances and regulations. ............................... (Signature Ef)/Fapplicant, or name, if o corporation) ..... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build¢ ..... ..................................................................................................................................................... Name of owner of premises..~¢~.~..~..~~~.~:~. ............................................................ If applicant ~s a corporate, signature of duly authorized officer· (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Mop No: ...................... ~......~,. .............. lot No' . ................ Street and Number ..../.../..~ .~.~..~'~.~...6...~..~..~...z(g/-~..~.~.~.....~..~'-~-~.¢CC':....~.....C~.. .................................................. Municipality (/ 2 State existing use and occupancy of premises and intended use and occupancy of proposed construction: · ' and -~)-'~. ~,z ,~ ~' · -~/ -, ~ a. Existing use occupancy....~ .......... :~ .................. ..... ~ ....................................................... b. Intended use and occupah~...:[~.' ,z~,~,~/..~,..'~.,,~/..~ ................................................................................................ 3. Nature of work (check which applicable). New Building .................... Addition .................... Alteration ................... Repair .................. Removal ................... Demolition .................... Other Work (Descr~be)/~:./.6.¢.~(".~/'~ 4. Estimated Cost....../...~....~...~....~.. ....................................... Fee ........... ./...~.~..,...m...c.-: ............................................................ (to be paid on filing this application) 5 If dwelling, number of dwelling umts .............................. Number of dwelhng umts 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 Stones ......................................................................................................... Dimensions of same structure with alterations or additions' Front ................................ Rear .............................. Depth .............................. Height .............................. Number of Stories .............................. 8. D~mensions of entire new construction. Front ........ ../.'~.~. .............. Rear ...... ~'.~/ ................ Depth .....K.~.. ................ 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......,cf~.~.~,_.~z~.~.. ................................................ 12. Does proposed constructional_ ,rw°late any zomng law, ordinance~ ;-- ~-- --ar r, egulation~ .:...-m~...~...~.g..: .............................. 13. Name of Owner of premises~...~...~..t<...~'.~..~.~Ff.?: ......... Address .,.~,..~.'.~.~..~,~1~....;:~...~...:....Phone NO ................... Name of Architect ................................. ,~ ..................... Address ........................................... Phone NO ................... Name of Contractor.?.c../.z.~.~...~..~.~.Y~z,&.c.'.~..~.~.~...~::....Address ................. I..! ....... .:.r.: ........... Phone NO 6/ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ex~stmg or proposed, and indicate all set-back dimensions fro~ property hnes. G~ve street and block numbers or description according to deed, and show street names and indicat whether interior or corner lot. EILEE. N G. NoJe,,'¥ Pubic, Sh~'e of New COUN~ OF ~.). ' p *~, Iv-- _ ............ ~~.~.....~., ...... ~~.~ ........ beln~ duly sworn, deposes ~nd s~gs that he is tho (Name of individ~~i~ above named. He is the ..... ~T~..~ ........................................................................................................ (Contractor, agent, corporate officer, etc.) of sa~d owner or owners, and is duly authorized to perform or have performed the said work and to make and fil this application; that all statements contained in th~s apphcation are true to the best of his knowledge and belief and that the work will be perCormed in the manner set forth in the application filed therewith. ~ Sworn t~fore me this ~ ................ ~ (Signatur¢~f applicant) ....... ............ .... o, .... ................... ......