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Home My WebLink About8456-z FORM NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION Q~.~,THE WORK AUTHORIZED) FORM. lq'O. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Di~pproved a/c INSTRUCTIONS a This application must be completely filled in by typewnter or in ink and submitted in triplicate to the Buildin[2 Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing Iocatior~ of lot and of buildings on premises, relationship to adjoining premises or public streets al areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of th~s application. c. The work covered by this application may not be commenced before issuance of Budding Permit. d. Upon approval of this application, the Building Inspector wdl 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 port for any purpose whatever until o Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of o Building Permit pursuant to thc Building Zone Ordinance of the Town of SouthoJd, 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 tc admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) ........... ........... ............ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ......... ~.~.(...~....~..r..~Z.....~..~. ................................................................................... If applicant is a corporqte, signature of duly authorized officer. (Name apcJ title of corporate officer) Builder's License No ..................................................... Plumber's bjce.nse No ................................................. Electrician's License No ............................................. Other Troc~e's l~jcegse No ............................................... Location of [anc~ on which proposed work wdl be done Map No ............................ ~. .... Lot No ......................... Street c~rtd INumber .~.~.~..d~,/..r.C,-......'~.....,~.~.....~..~..~.~...C~.Z.~....~.~..~:.~.:.~.~ ..... /.'-~..4T~f~.:/~......':~..'/..~-....' ......................... / Municipality St(~te existing use anc[ occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting ,se and occupancy ......... ~...../~.~.~..~. ................ · ./~..~....~)....~. ..................... ?....~. ............................................... b. Intended use and occupancy ................... ~n:..~. ..~...~..~...,C~..~ .......................................................... 3 Ncture of work (check which opphcobie). New Btuld~ng .................. Addition ................ Alteration Repa,r ............. Removal ............ Demoht,ar ....... O?her Work .~. ~..~../~'- -- - 4 Estimated Cost .Z(~. ~...~. ................................... Fee .~..~....~ ...................................................... (to be prod on fihng this apphcahon) 5 If dwelhng, number of dwelling umts ..................... Number of dwelhng umts on each floor ................ If garage, number of cars .......................................................................................................... 6 if business, commercial or mixed occupancy, spec,fy nature and extent of each type of use ........... 7 D~mers~ons of ex~stmg structures, if any' Front ......................... Rear ................................Depth ............... Height ..................... Number of Stories ................................................................................................. D~mens~ons of same structure with olierat~ons or additions: Front .................................... Rear ...................... Depth ......................... Hmght ...................... Number of Stor~es ...................... 8 D~mens~ons of entire new construction: Front .................................. Rear ...........................Depth ............... Height ................. Number of Stories ............................................................ 9 S~ze of lot Front ................................................... Rear .................................. Depth ........................... 10 Date of Purchase ............................................... Name of Former Owner ...................................................... 11 Zone or use d~stnct in which premises are situated ............................................................................ 12 Does prooosed construction wolate any zoning law, ordinance or regulation ........................................................ 13 W~II lot be regraded .......................... Will excess fill be removed from premises ( ) Yes ( ~) No 14 I',~ame of Owner of premises ~' ~ Address Phone N~. Name of Architect ........................................ Address ................................ Phone No ....................... f'¢,:me of Contractor .......................................... Address ................................ Phone No ....................... PLOT DIAGRAM Locate dearly and dmtmctly all buddings, whether ex~st~ng or proposed, ~nd mcl~cote all set-back dimensions from orop~.rty hnes Gwe street and block number or description according to deed, and show street names and ind~ te whether rater,or or co~ner lot- ~ .cTz\TE OF NEW YC~K//~,~ t~ CGUNTY OF . .~ ./~-czZ....fo's .......................................................................... being duly sworn, der~oses and seys that he is the apphcarn (Name of mdiwdual s~gnmg contract) above named He ~s the ...................................................................................................................................................... (Contractor, agent, corporate officer, otc ) of s~d owner or owners, and is duty authorized to perform or have performed the smd work and to make and th~s apphcat~on; that ail statements contained m this apphcct~on are true to the best of h~s knowledge and beheF, that the work will be performed m the manner set forth m tk.e apphcation fj,~ed therewith Sworn to before me this / /? of , t ///,,/ '. .......... ..... JUDI'tH T. BOI(EN (S~gneture of apphcant) ~c. 52-034496:3 Suffolk County Ccmrmss~en .~xplres M~ch 80, tg_.~./