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HomeMy WebLinkAbout8440-z F0~,~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8440 z Permission is hereby granted to: ....... :.......~.~A;L~ ........................................... ~t premises located at; .-,-~l~-~.Pe.~-.A.~e~- ............................ ; ............................................................ ~.~-<~ ................................... :...:~.:.~..,:...~~ ..... ~.~, .................... :...t ........................... ~: ................ '~:. pursuant to aDplicahon d~ ,,' ~ ~ 19 ~ and annmved-by th~ ~':~"~ Building Inspector. , - ........ ; .............. Fe~~ $ ........... :* ~ . ~ Approved ........................................ , TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Disapproved a/c ............................ ~ . ~ APPLICATION FOR BUILDING PERMIT Date INSTRUCTIONS o. This opplicatfon must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildinc Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing Iocatfor~ of lot and of buddings on premises, relationship to adjoining premises or public streets of 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 issuance of Building Permit. d. Upon approval of this application, the Building Inspector wdl 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 Occupano, 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 thf Budding 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 applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in buildings for necessary inspections. ................ .~.(Signature of applicant, or namp, if a corporation) (Address of applicant) State whether appli~;~g~ i~.~wner,~essee, agent, architect, eng,neer, general contractor, electr,cian, plumber or builde, ........................................... · ..................................................................................... Name of owner of premises ................................................................................................................................................ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ...... ~..~.~ ...........~-C~ Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... Locatmn of land on wh~ work ill be done Map No /~ ........ Lot N .............. Stree and Number ............................................................................................................................................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o Ex,s,ting use and occupancy ....... ~.~....~.~ ...... '"'.~7"""'~"" '"'"'""""""""'"'"'"'"- b. Intended use and occupancy ............................................... "~ ~- ~ '"'/ //"'~'"'~i~iiiiiii' ................................... 3. Nature of work (check which applicable) New Bu~]dmg ................ Add,ban ............... Alt?ration Repair ................. Removal .................. Demohtlor. .................... Other Work ..... ~,f~ .................... (Der~ription) 4 Estimated Cost ....................... ................ Fee ................................... .............................. (to be pa~d on fihng this application) 5. If dwelling, number of dwelling units .........................Number of dwelhng units 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 ........................................................................................................... D~mensions of same structure with alterations or add,hans. Front ................................... Rear ....................... Depth ................................ Height ......................... Number of Stones ................................ 8 Dimensions of entire new construchon' Front ................................. Rear ............................ Depth .................. Height .................... Number of Stories .......................................................................................................... 9 S,ze of lot' Front ................. ?..."~...('. ............................. Rear ...... ~.../~.~ ....... Depth ......~...6..?.. ........... 10. Dote of Purchase ..................................................... Name of Former Owner ....................................................... 11. Zone or use d~stnct in which premises are situated ........................................................................................ t2 Does proposed construchon wolate any zoning law, ordinance or regulahon' . ..................................................... 13 Will lot be regroded ............................ Will excess fill be removed from prBmises: ( ) Yes ( ) No 14. Name of Owner of premises/~J.../..~..~, .~m.. ........ Address~:W~,rt~.~/~..,/'/~Phone No~..;/.C..,..~..~..~..~' r Name of Architect ............................................... Address ................................ Phone No ..................... Name of Contractor ................................................Address ................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buJIdmgs, whether ex~sting or proposed, and red,cate all set-b~=ck dtmenslons fro~ propcrty lines. Gwe street and block number or description according to deed, and show street names and ind~cat whether interior or corner lot STATE OF NEW ;S.S COUNTY OF d'o being duly sworn, deposes and says that he is the opphca (Name individual signing contract) above named He ~s the ............................................................... ~-~i;~.e,~. ................................................................................ (Contractor, agent, corporate officer, etc ) of sa~d owner or owners, and ~s duly authorized to perform or have performed the said work and to make and f this apphcation; that all statements contained m this apphcat~on are true to the best of his knowledge and behef; a, ti,at the work will be performed in the manner set forth in the apphcation filed therewith Sworn to before me this Notary Pubhc, . .................... ~.0.~ .............. County .. ...................... ~BETH A~l~l ~£VlLL£ NOTARY PUBLIC, State of New Y, ~ No 52 8125850, Suffo]l~ ~ Term Expires March 30