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Home My WebLink About8307-z I~RM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK ^UTHORIZED) N? 8307 Z Permission is hereby granted to: FO~M NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. ¥. ....... .......... ............ Approved .............. '.! ....... f-..Z ......... , lg~.~Permit No...,~...,.~.....~....Z.~.. Disapproved o/¢ .........~_._-.._...._....... ~...; ........................ ............... ............... ............ ........... I NSTRUCT'IONS a. This application must be completely filled m 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 location of lot and of butldtngs on premises, relationship to adjoining premtses or public streets or areas, and giving 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 apphcation, the Building Inspector will ~ssue 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 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 the Buildtng Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicc~nt agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. 'g pplicant, or n~e, 'f a corporation) ...... (Addre;; o~"~ii;;;~'''z ......................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................................... ........ : ................................................................................................................. Name of owner of premises ...... ~../j-.~..:....~./...~.....~.../...~:........L?.... ~./..~.....~...~..~.. ~ ~ .~. ........................................................... If ap~licanl Ds a corporate, signature of duly authorized officer. (Name and titlet~:~{ corporete officer) Builder's License No ......... ~...~..~..~.~ ........... Plumber's License No ................................................. Electrician's License No ............................................. Other Trode's License No ............................................... Location of land on which proposed work will be done. Mop No · ..~,. ..... :... ~ .................... Lot No ........................ Stree~ and Number ............. ...~...~...~....~... ..... ~,,~...~..~...~.~.?. ........... .~./..~......-~....C~....~..../cl'..?.. ....................................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction' a Exisiting use and occupancy ~/'~(~ - b. Intended use and occupancy ........ .~.....~...~...~.../...~..~. ............................................................................................... 3. Nature of work (check which applicable) New Budding .................. Addition ................. Alteration ............ Repair ................. Removal .................. Demoht~or. ................. Other Work .................................................. (Description) 4. Estimated Cost ..................................... ...~.: ................ Fee /.... ~... .."'"' " .................................................................. (to be prod on fihng th~s application) 5. If dwelling, number of dwelling umts ........................ Number of dwelhng umts on each floor .......................... 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 ex~shng structures, if any: Front ........................... Rear ................................Depth ................... Height ........................ Number of Stories ............................................................................................................. D~mensions of same structure with alterahons or additions: Front .................................... Rear ....................... Depth ................................Height ......................... Number of Stones ............................... 8 Dimensions of entire new construchon: Front ................................... Rear ............................ Depth .................... Height .................... Number of Stories ............................................................................................................... 9. Size of lot' Front ....................................................... Rear ........................................ Depth ............................... 10. Date of Purchase ..................................................... Name of Former Owner ....................................................... 11. Zone or use district in which premises are s~tuated ............................................................................................... 12 Does proposed construchon violate any zomng law, ordinance or regulahon ....................................................... 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 ...................... Name of Contractor .................................................. Address ................................ Phone No ...................... PLOT DIAGRAM Locate clearly and distinctly all buddings, whether ex~sting or proposed, and red,cate all set-b~ck dimensions fror property lines Give street and block number or description according to deed, and show street names and indicat whether interior or corner lot / / STATE OF NEW~;;}RK, .~ /7,I~ I S S ~'~ COUNTY QI~ .~ .... .f°~ ................ ~.~ ...... ~.~f ................ be,ag duly sworn, deposes and says that he ,s the opphca above named. He ,s the ............ ~f~o (Contractor, agent, corporate officer, etc.) of sa~d owner or owners, and is duly authorized to perform or have performed the sa~d work and to make and fi this applicahon; that oil statements contained ~n thru apphcation are true to the best of his knowledge and belief; a, that the work will be performed in the manner set fo~h in the application filed therewith. ..................... aov ............... ................... ..... ....................... ~ ~ VELiZABETH A~ NEVILLE ~ Expires M~tch ~,