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Home My WebLink About8154-z FOEM 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? 8154 Z Dote ............................ AII~ ...... '~9 ......... 19....~/~ Permission is hereby gronted to: ~in..r. oek..~.enea..¢a...at/Ct..Staule¥.. .................. .~.a..~_~..L~.~, ....................................... to...e...r..e..?.~...&.....m...a....~...t_a....~......b_.f~....h;1,g~!...l~;L~k.e.~t...feae;h~g _.-....tool,...Fa~tt..a~.ea .............. at premises locoted ot .]~O~.~it.,.: ............. ]~&~.,~!~q~g ............................................................... ........................................................ Lee.~d.. ~ r i,v.e ......... .SouthoSA ............................................ pursuant to application dated .......................~AJ~....-.*~' ................ 1~.~...., and approved by the Building Inspector. Fee .......... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .................. 19....?.~ Approved ............... '.!, ,~'~.. ...... L...~...., 19 ........ 7~ Permit No. ,.~,./...~,T..~/.-.~ ..... Disapproved o/c ...~ ......... : ........ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS o. This application must be completely filled in by typewriter ox in ink and submitted in triplicate to the Building'~', 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 oF '~ areas, and giving o detailed description of layout of property must be drawn on the diagram which is part of this applicotion~,~,~ c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept an 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 hove been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment for the issuance of o Building Permit pursuant to the ~ Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lows, Ordinances or ~ Regulations, for the construction of buildings, additions or o~terotions, or for removal or demolition, os herein described./ The applicant agrees to comply with oil applicable lows, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in, buildings for necessary inspections. (Signature of applicant, or nome, if a corporation) ........ (Address of applicant) State whether 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 ............................................... ~ ' - ~ ' Location of land on which propos~d¢,,_~ ,~ /~ ).w°rk will be done. A/~m9 No.: ............/......'~.::. ....... , ........ ~_~.kot,~o~.....~ .................. Street and Number ......... g2~:~KT/~k-~(.~.....,¢;~1......: ........................ ~~~ .............. Municipo State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy .................. ~,...,..~...~~/ ............ -.-,,-~, ........................................... ,, b. Intended use ond occupancy ........................................................... ~'~'~'-~'"~'~/ ............................. 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ................. Repoir .................. Removal .................. Demolition .................... Other Work ............... 4. Estimated Cost ............................................................ Fee ....... ./....~_.....;-'~.. ................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling 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 Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ................... , ................ Rear ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................... 9, Size of lot: Front ............. ~..0. ............................... Rear ........ ~..C). ................... Depth ....~..~.....~. ............. 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 1 I. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded ............................ Will excess fill be removed from pr~mises: (,) Yes ( ) No ............................. ~.Cd....'~.. ....... Address ..... ~ ...~?/Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name af Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW Y/~DRI,9,j -~ / ~ S S COUNTY Ot~.~..~,.,.../,~..,..I' ' ~, .~..~..~.~" ...... being duly sworn, deposes and says that he is the opplicam (Name of individual signing contract) above named. He is the .................. .~~~~ ...................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and fife this application; that ali statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set foffh in the application filed therewith. ~ Sworn tAbefgre me this ~ , -- ~ / I ...... o, ...... ...... ,, . _ . ................... .......... ~ , ~ ~ ~ _ ~ ' ~ (Signature of applicant)