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Home My WebLink About8388-z F~R~ NO. 2 TOWN OF SOUTHOLD BUILDIHG DEPARTMENT TO~,YN CLERK'S (N:FICE SOUTHOLD, N~ Y. ~o 8388 Z Permission is hereby granted' ~'o: BUILDING PERMIT (THIS PERMIT 'MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No....(~....~,.....~......~'~..........~... ................................ '~Y'~" ......... ~'"1 .................. '-'~ .............. .............................//' L..L....C;..; ................................................ (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ............ ....... I NSTP, UCTIONS a. Th~s apphcabon must be completely f, lled in by typewriter or' in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plat plan to scale. Fee according to schedule. b. Plot plan showing Iocahon of lot and of buildings on premises, relationship to adjoining premises or public streets o~ areas, and giwng a detailed descnption of layout ofproperty 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 Budding 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 a Building Permit pursuant to the Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, addihons or alterations, or for removal or demolition, as herein described The applicant agrees to comply with all apphcable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. ......... (~'ignature of a~ii;~"~";~';~';';;;i;~i ........ ...... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electricmn, plumber or buiIder. Name of owner of premises ... I..~./~. ....... 1.~. ........................................................................ If apphcant is a corporate, s~gnature of duly authorized offmer. (Name and title of corporate officer) Builder's Lmense No ........... ~ ................ Plumber's bcense No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... /~ ~/ 1 Location of land on whichn4~~roposed work will be done Mop No .................................. Lot ,N,o ....... .x. ............. Street and Number . ../'~/.~/TJ./'~.~..~?..~..../~.~. ..................................................................... ~,~ .~,,x,.'~.J..-f~...~ .... Municipality 2 State existing use and occupancy of premises and in~.ended use and occupancy of proposed construction' a Exisit,ng use and occupancy ....... .~.......~.,~.~'~X....~.'~"X ../~-~..~,-g ~.;..~-. ................................................................ b Intended use and occupancy .... ~../~.f~-4~..~....;~'x~./~. L~.. ..... /. ~....~Y..t~x~ ................................................................... 3. Nature of work (check which cable). New Building .................. Ad n ................ Alteration .: ........... Repair ............... Removal ............... Demol,tlor. ...............Other Work ...~.~4~-.Z-/.~..~....~...~.....-~..~..~...~?..~'~ (Description,)I 4 Estimated Cost -~' Fee (to be paid on filing this application) 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, specify nature and extent of each type of use ......................... 7 Dimensions of ex~sting structures, if any Front .........................Rear ................................ Depth .................... Height ........................ Number of Star,es ........................................................................................................... D~mensions of same structure with alterahons or additions Front .................................... Rear ...................... Depth ................................ Height ....................... Number of Stories .............................. 8 D~mens~ons of entire new construchon: Front ................... , ................ Rear ........................... Depth .................... Height .................. Number of Stories ................................................................................................. 9 S~ze of lot Front .............. ]~.~. ................................ Rear ........... J..~...q ..................... Depth ........ .~...c?.0. ............. 10 Date of Purchase ............. ]...~¢;.¢. ........................ Name of Former Owner 11. Zone or use d~stnct in which premises are s~tuated ................................................................................................ 12 Does proposed construction violate any zoning law, ordinance or regulation ........................................................ 13 WHI lot be regraded ....... ..~...0 ............. WHI excess fill be removed from premises: ( ) Yes ( ) No ' ' ' /¢...'~¢.~x.~..t¢..O ...... Phone No..~2...~.~.~...¢.~ 14 Name of Owner of premises..~.F./~/.¢;~.....~.~.~./2, z~. ............. Address ................ Name of Architect .............................................. Address ................................ Phone No ...................... Name of Contractor ........................................... Address ................................ Phone No ...................... PLOT DIAGRAM Locate clearly and dzstmctly all buildings, whether ex~stmg or proposed, and mdmate all set-back dimensions fron- property hnes Gwe street and block number or descnphon according to deed, and show street names and indicate whether interior or corner lot STATE OF NEW~C. ORI¢-/.4' ~- ~ c c COUNTY OF ...................... ~-x~"~'~'-. ~.~~.c.~ ............ being duly sworn, deposes and says that he l$ the (Nam~6~dmwdual 's~gnmng contrac~ ' above named He ~s the ...................................... ~~ .......................................................................................... (Contractor, agent, corporate officer, etc.) of sa~d owner or owners, and is duly authorized to perform or have performed the so~d work and to make and fdc this apphcotton; that all statements contained in thts apphcahon ore true to the best of his knowledge and behef; thor the work will be performed m the manner set fo~h ~n the apphcahon filed therewith. Sworn to before this ~ . ................. o, .......... ...... Notaw Public,. ................ ~~L .... Coun~ ............ t....~~¢ ........ ~~ ......................... NOTAry PUBLIC, Sfa~e o Commission ~xplres Mar~b 30,