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Home My WebLink About8306-z FO~M NO. 2 TO~'N OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~. Y. BUILDING PERMIT CI"HIS PER~!T MUST BE K,~T ON 'THE PREMISES ~NTIL FULL COMPLETIbN OF THE WORI~ AUTHORIZED,~ i~ 8306 Z Date. . , 1 ~. ........ ~...~...x...~: ............ ..~ ~ p~,~,~ ~o~o~ ~ ..~.~.~,.~...-...~,,.. ..... ....................................................... : ..... ~ ~,..:..: ..... ~ ~ ................................... ..... ................ Building Ink.for. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTNOLD, N. Y. .... Permit ..... Disapproved a/c ............................................................................................ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This. applicahon must be completely filled :n by typewriter o~ in ink and submitted in triplicate to the Buildim Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b, Plol plan showing Iocahon of lot and of buildings on premises, relationship to adjoining premises or public streets o areas, and giwng a detailed description of layout ofproperty must be drawn on the diagram which is part of this application c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Budding Inspector w~ll issue a Building Permit to the apphcant. Such permi shall be kupt 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 o Building Permit pursuant to th. Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances c Regulaho,s, for the construction of buildings, additions or a;terations, or for removal or demolition, as herein describe, 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.~necezs~ary~/,~,~, inspections. ~.~, , State whether applicant is owner, lessee, agent, architect, engineer, general con, tractor, el~trician, plumber or builde ~.~..Z.-......-.-. Name of owner of premises ....... ~.....~....., ............ ..~~~ ........................................................... // If applicant is a corporate, s~gnature ~of duly authorized officer.~ (Name and title of corporate ofhcer) Builder's License No. ~ Plumber's License No ................................................. Electrician's License No ...... ~ ........................... Location of land on which pr~pose~/r_k ,ill b~ don~,,J~p No ..... .~ ...... '.~.~.~.~ ...... Lc~t No..~... ............ Street and Number .~.~..~. ..... ~.~.~...~- .~~,~.:~-4~. ..................... ~~.- State existing use and occupancy of premises and intended use and occupancy of proposed construction: a Exisiting use and occupancy ..~~ .................................... Repair .................. Removal_..~,r .......... Demolmor. ............. Other Work ..~?.~ ........................... /f~_,~..~ ~) ~. ---- ~ /~'-- ,,~,~3~ ,,// (Description) 4 timoted Cost ................... ........... Fee .............................................................. (to be pa~d on filing th~s apphcation) ........................... Number of dwelhng umts on each floor .......................... 5 If dwelling, number of dwelhng units If garage, number of cars ................... ~ ............................................................................................................ 6 If business, commercial or m~xed 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 addmons' Front .................................... Rear ........................ Depth ................................ Height ........................... Number of Stones ................................ 8. D~mensions of entire new construction: Front .................................... Rear ............................ Depth ...................... Height ..................Number of Stories ........................................................................................................ S,ze of lot Front ..... '-----.~......~.. ................. Rear .~....'~-~.. / De,~h 9.10. Date of PLrchase ...........i....~'.~.' .~.'~.'~.'.'~.'.~.'i"iiiii'i'iilNome ~; F~'r~;'~-J~..~'.... ..... '~.~. '~.. ... ............. .......... 11. Zoneorused,str,ctinwhichprem,sesar/,tuated...(.~'..~....~../. ..................... ~ .................................... /... 12 Does proposed construchon wolate any zoning law, ordinance or regulation: .... ~ ...................... .....~ .......... V'.. 13 Wdl lot be regraded .......................... Will excess fill be removed from premises' ( ) Yes ( ~ No 14. Name of Owner of premises .................................................... Address ................................ Phone No ...................... Name of Architect .......................................... : ...... Address ................................ Phone No ...................... Na~e of Contractor ................................................ Address ................................ Phone No ...................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ex~stmg or proposed, and in&cate all set-back d~m, enslons fror property hnes Gwe street and block number or descr~phon according to deed, and show street nam. es/and ind~cat whether inter~or or corner lot . /'V' STATE OF NEW YORK, ~S COUNT'( GF .... 8%%f:f.O.].~ ........ f S ............... ;;.~t..3.3.,~1~....~v;..~...3.~ ........... ;, ................ being duly sworn, deposes and says that he ~s the apphca u'qame aT mow~auQi signing COntrQeT) above named He ~s the ...................................... O~7~e~' .................................................................................................................... (Contractor, agent, corporate officer, otc of sa~d awner or owners, and ~s duiy authorized to perform or have performed the sa~d work and to make and f this application; that all statements contained m this applicat,on are true to the best of his knowledge and belief; a that the work will be performed in the manner set forth in the apphcahon filed therewith. Swam to before me th,Sot 19...~. ~"~~~4 ,~,gnarure or o ~""~'/'" ~"~ ........ · 1 Cj,~. ..... day .... ]~i~lD¥'4illt~ e~. ............. , Nata ........................... ...... Co.n .... ................... ;;.:....:...........=... ................. ELIZABETH ANN NFVILLf~' 4%~ 52-812585r), Sltffnlk Counfv 7erin £xp~res March 3r~