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Home My WebLink About8391-z FO~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. N°. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 8391 Z Date ......................... .~.til.~.....~. ............. , 19.~J~.. Permission is hereby granted.to:. ........ ;..: ....................... ~ ............................................ :. ~. . . . . .~. . . . . . ~.*. .*. . :~ ~. . .~. . .. . . ~ ~.~ .e.*. . . . ~ ~ ,. .~. . .................................................................. promises located at ...... .~.~: ........................................ : .................... '"" ~ : ............................................ :'~"~=*~ .... ~*~' ............................................................. :~ .......... : ...... ~ ................ ;:,' ...... ,.i ....................... :...: ...... :.::....::.:....: ............................................. ~' ~to ?pplication dated ........ ;. ............................. ~ ............ , 19..~.t~ , and approved by the ~p u^--roye'~ ~ ' ~ FO~Z~r NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 19 ......Permit No."'~ ~ ~' / ~ Application No .... '~"'~"~'I ........... INSTRUCTIONS a. Th~s apphcation must be completely filled in by typewriter or' in ink and submitted in triplicate to the Buildin.~ 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 o areas, and giving a detaded description of layout of property must be drawn on the diagram which is part of this application c. The work covered by this apphcation may not be commenced before ~ssuance 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 issuance of a Building Permit pursuant to th, Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described The apphcant 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. ...~.....(;~i.l.t~.f.~..a~?..i..~.~.~...~./..,..~./..~...~..~TT,~nt, j~r name, if a~corpo .~.~..o~..i...~..~ (Address of applicant) State whether apphcont is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder If applicant ~s a corporate, signature of duly authorized officer. (Name and t~tle of corporate officer) Builder's License No ..................................................... PJumber's L~cense No ................................................. Electrician's License No ............................................. Other Trade's L~cense No ............................................... ~ Location of land on which proposed work will be done/'~Aap No~ ......................... Lot No ~ Street and Number (2~,~. j b2 ~_ ~ P '~- / ',~..,~.iL-'! ~ "~ ~-~' .'.~..~'~"~1"~'~'~'~ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction' 3 Nature of work (check which applicable) New Building ............ Addmon .............. Alterahon ............. Repmr .................. Removal ................ Demolmor. ................ Other Work .............................................. (Description) (to be pa~d on fihng th~s application) 5 If dwelling, number of dwelhng 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~sttng structures, ~f any Front ...................... Rear ................................Depth ................ Hmght ........................ Number of Stones .......................................................................................................... D~mens~ons of same structure with alterations or addmons Front ................................... Rear .............. Depth ................................Hmght ................... Number of Stones ............................. 8 Dimensions of entire new construction' Front ........ ................... Rear.....~. ....................Depth ..... J.C~) ..... Height ................... Number of Stones ..... ~..~ ..................................... 9 S~ze of lot. Front ............................................... Rear .................................... Depth ............................ 10 Date of Purchase ...................................................... ~ame or[ Former~Owner ...................................................... 11 Zone or use d~stnct in which premises are situated . . ~J. .......... ~ . ~. ............................................................. 12 Does proposed construction wolate any zoning law, ordinance or regulation ........ ~ ........................................ 13 Will tot be regraded .......................... W~II excess fill be removed from premises:~ ) Yes ( ) No Name of Architect ............................ Address ................................ Phone No ....................... Name of Contractor ....................................... Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ex~stmg or proposed, and red,cate all set-back d~menslons from property hnes Give street and block number or description according to deed, and show street names and red,cate whether interior or corner lot STATE OF NEW Yg3RK,,z ~// ~cc COUNTY OF ~f ~ ~ ...................................................................................... bmng duly sworn, deposes and says that he ~s the apphcam (Name of md~wdual s~gning contract) above named He ~s the ................................................................................................................................................. (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 ill- this apphcat~on, that all statements contained ~n th~s apphc~hon are true to the best of his knowledge and behef; an~ tha~ the work will be performed in the manner set forth m the apphcation filed therewith Su [~t'k County