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Home My WebLink About8414-z FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N~. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8414 Z Permission is hereby granted to: ...ateJ~l~....l~ ........................................... ................. 8~at:lt*~....~,~, ....... :....: ................ to !. at premises located at ..... Wj~jJ-.JJ~J%l~..~ .............. J~l~.f.~ ........................................... ~. ....... :. · ...................................................... ~_____. _..._ J~t,~....~-.x,.~. ............................................. :.,.,"..:=~ ............... =~,~. ,..-~pu~Bant~=~ := to application dated. ........................ ~. ..... , '., and ~ed th~ ~,~ ~- 'B in~ Inspector. ' -' ' s', , '. Examined .........?~...~J~... ....... {....., FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. ¥. Disapproved a/c ....................... __ AFFLI~ATION FOR BUILDING PERMIT INSTRUCTIONS No. (' /' Application ....(~...../......~. .......... a. This application must be completely filled in by typewriter o~. 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 buddings on premises, relahonship to adjoining premises or public streets o areas, and giving a detailed description of layout of property must be drawn on the d~agram which is part of this application c. The work covered by this application may not be commenced before ~ssuance of Building Permit. d. Upon approval of this application, the Building Inspector will ~ssue a Budding Permit to the applicant. Such permi shall be kept on the premises availabJe 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 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 alterahons, 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 t, admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) ........... ~ ..................... ~.; ...... %..-,~. .......... ~ .,'; ....... ~ ............ {~ddress of applicont} State wheth~: applicant is owner, lessee, agent, 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 ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... /~- Ma No Lot //' . Locahan of land on which .proposed work vzi~l be done p ...................................... No ...................... Street and Number ...~.~......~..~...~.~.~..'....~.m~..~.~-~...~. ................................................................. (/ Municipality State existing use and occupancy of.,,~z~ ise, ~o~nxte,~nded use and occupancy of proposed construction- a. Exis~ting use and occupancy ...~~..~ .......... ;~ ..... ..~ ................................................................ b. Intended use and occupancy ...................... ~.k,. ......... .J. ............... ~/~Z.--~..?....~-...~ ................................................. ~ 3. Nature of work (check which apphcable) New Budding ............ Addition ......... Alteration ........... Repair .................. Removal ............... Demotitlar ............... Other Work ..~.~..~..~ ~ ~ (/ (Description) 4. Estimated Cost ..... .'.~.~...~...~.a....~.~. .......... Fee .... / S. c ~ (to be pa~d on filing 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 rmxed occupancy, specify nature and extent of each type of use ........................ 7 Dimensions of existing structures, tf any Front ...................... Rear ................................ Depth .................... Height ........................ Number of Stor~es ..................................................................................................... D~mensions of some structure with alterations or additions. Front ................................... Rear ........................ Depth .......................... Height .... Number of Stones ....................... 8. Dimensions of entire new construction' Front .............................. Rear .......................... Depth .................... Height .................. Number of Stories ........................................................................... ~'"'7 .......... 9 S,ze of lot. Front ............. ~...~.~ ................................ Rear ........2..~ ....................... Depth ...... ./....~....~. ............. I0. Date of Purchase ............................................ Name of Former Owner ....................................................... 11. Zone or use district ~n which premises are situated ............................................................................... 12 Does proposed construction violate any zoning law, ordinance or regulation' . ...................................................... W~II lot be regraded ........................ W~II excess fill be removed from premises. ( ) Yes ( ) No 14 Name of Owner of premises ......~.~.~...~..c."..~Address .~...z~../4~...~.~..~:.~. .... Phone Name of Architect ................................... Address ................................ Phone No ...................... Nome of Contractor .................................. Address ................................ Phone No ...................... PLOT DIAGRAM Locate clearly and d~stmctly all buildings, whether ex~sting or proposed, and red,cate all set-back d~mensions fron propcrty lines. Give street and block number or description ~ccordmg to deed, and show street names and ind~cat- whether interio_/_r or corner lot ~ S' f STATE OF NEW YORK, [ S.S COUNTY OF ........................... ................................................................................... being duly sworn, deooses and says that he ~s the opphca: (Name of individual s~gmng contract) above named He is the ......................................................................................................................................................................... (Contractor, agent, corporate officer, etc) of sa~d owner or owners, and is duly authorized to ~erform or have performed the sa~d work and to make and fil th~s application; that oil statements contained m th~s apphcct,on are true to the best of his knowledge and behef; a~ tk, a~ the work will be performed m the manner set forth in tk.e apphcat~o:n filed therewith. Sworn to before me this ., , _ ........................ ................ ...... , Notary Public,. ................................................... County ...~'.....~. .............. -" (Signatur~ of applicant)