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Home My WebLink About8399-zNO. 2 TOWN OF SOUTHOLD BUILDING ~EPARTMENT TOWN CLERK'S OFFIGE $OUTHO!o· N. Y. BUILDING I~ERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CO~Pi-E~FI~N OF THE WORK AUTHORI2~ED) N°. 8399 Z ~te .................... '. ......... i..~.A..~....~ .... ., Pe~issi~ is he;e~ gren~t~ to: ~ ~.~...~..~.~..r ...... .~.~.~.~..~.~ ........ ~- to .... : ...... ; ................. ~? · ....................... ~ ....... : ..... ~ ~,-- ~.,: ..................................................................................................... to_~p~hccti~g acted ....................... ; .....~.~,, ~ ]g~ , ~nd approved by Bufld~ng Inspector Examined .................... ~?....~., ~a~oproved ........................ . ...~....~......~.., FO~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 19...~.,4. 19...~. Permit No ..... ~..?....-~......'~.. ........ Application No .... ..?...,~..., .~.., .-?. .......... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date..~.~.. ......... .~.~ ................ INSTRUCTIONS a. This application 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 detailed 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 will issue a Budding 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 c Regulahons, for the construction of buildings, additions or alteratio~ j~al~-~nblll~n, as herein describer The applicant agrees to comply with all apphcable laws, ordinan~i~, bL Idin~l~ r~, ~rusing cod~,/~nd regulations, and t admit auth°rized inspect°rs °n premises and in buildings f°r (~ecels~J~ ~?~_i, ~ ...... ..... .... .... Ad~s of '~p~i~ ..................... ~'' State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde, ............................................. .= .............. ........ :: .................................... ..................................................... Name of owner of prem,ses ...,.%~.j.,z.~_~).~..~........'~....~..j~..~O..x ,.~...-~......~.~.~.,.~.~...,..'~.~ .............................................. If opphcant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... Location of land on which proposed work wilLbe done. Map No.' ............... [..-~.J ................ ,. Lot~ No....5 ........... Street and Number ..l.\.~.~..i?.(~,.(,g.~.~.C....~...~.~.....~J..~..i-- ......... .~.~,~.¥.~..~,.~.: ......................... Municipali~ State existing use and occupancy of premises and mntended use and occu~ncy of proposed construction- o Exisiting use and ~cupancy b Intended use and occupancy '~"'~'~%~'~"' '~¢';~'"~ ~'~'"~ ','~5'¢' .................. 3 Nature of work (check which apphcable) New Budding ....... Addition .......... Alteration ............ Repair ......... V/~ ..... Removal ................ Demolit~or '"Jl ...... Other Work~..v'~.~ ..... ..~....~.~..~.......~...~7.~ ....... ~' ~ ,~ ,~ (Description) .......................... ...... ............................................................ (to be prod on fihng this applicahon) 5. If dwelling, number of dwelhng units ........ ~ .......... Numbcr of dwelhng umts on each floor ....... .~.~ ........ if garage, number of cars .................... ~.. 6. If business, commercia~ or m~xed occupancy, spec,fy nature and extent of each type of use ........................ 7 D~mens,ons of existing structures, ~f any Front ......... ~ ........... Rear ...... ~. ................... Depth ...~ ........ He,ght ........ ~ .......... Number of Stones ......... ~ .......................................................................................... D~mensions of same structure with alterahons or eddmons' Front ............. ~ ............. Rear ....~ ............ Depth ........ ............... He,ght ....... ........~, ~__.,Number of Stories ...... 8. D,mensions of entire new construct,on Front 4~.'.~ ........... Rear... '~ '"'"'"""""Depth[~....~ Height .............. Number of Stones .............. ~ ................. ~ ............................. r~ " ....... : ...... ' ...... 9. S,ze of lot. Front ..~t0.~ ..................... Rear .... ~.C'C~ ........................... Depth .L].~..~.~...,'~ 10. Dote of Purchase ......~ ~. ...... ~.~...L~ ................... Name of Former Owner ~.~..~.~.~.~ ............. 11. Zone or use district in which premises are s~tuated ...................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation .......... ~.~ ........................................ 13. Wdl lot be regraded .......... ~.~ ........... Will exc~s fill be removed fro~ ~emises: (,) Yes ( ) No 14. Name of ~ner of prem,ses~ ~....~~ ...... Address ~.~...[~. Phono No.~.~.~.J~ Name of Architect .................... Address ................................Phone No ..................... Name of Contractor ..................................... Address ................................Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly ~11 buddings, whether ex~shng or proposed, and mdmate all set-~ck d~mensions fror prope~y lines Gwe street and ~[ock number or descnphon according to deed, and show street names and indicat whether interior or corner lot . STATE OF NEW YO~Kk.-,-~ A r, o ~ S S COUNTY OF .... ~.,~.. ~'~..~,.~.. ~ ~ ......................... '.~7.0..~.~.\ ...... -.~.~..~.........~.....~..~.~.~.~ be,rig duly sworn, deposes and says that he ,s the apphca: (Name of individual s~gnmg contract) above named He is the ....................................................(~..~..~.:~.~.... ......................................................................................... (Contractor, agent, corporate officer, etc ) of so~d owner or owners, and is duly authorized to perform, or have performed the this opphcation; that all statements contained ~n th~s appl~c _ the b,est oJh:~ I~owledge' and belief, a~ that the work will be performed in the manner set forth ~n tj~ ap~hcahon fllgd.~t-Pi~re~vjJ'h~ ~ Sworn to before me this ~ .: I ~ )( ~ \ . / ......... · ~....~.. ....... day of .... ~..4d2...~..~..~....~.. , 19~. Nato. Pub,ic, ....... Coun ......... 'q:~ZL,~'-~4 k.~ k.., k~ , ~ ~ (Sign~tu-~e o~ c~phcont) THOMA3 J. BOEQEI. Notary Fubhc, State of New York No 30 ,"355630 Quahf,ed m Nassau Cognly l~rnmlsslon ~xplres March 30.