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Home My WebLink About7800-z FORM NO. 2 ~'OWN o~ sou~.sOLo BUILDING DEFARTMEHT SOUT~O, N~ Y. · BUILDING PERMIT (THIS PERM~T MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7800 Z ~5 .... e~ect feneing: on farm 1~ a~ .~.e~ ..a.p.~lieatio~ file~, at premises I~ated at ..... $~,.~.~. ............. ~.;.~.~ ........................................................ ....... ~ee~or~ ~.~, . Oursuont to oppllcofion dated ................ : ........ ~.~[ ....... ?(. ....... , 1~...., ~nd opproved by the Dui[ding Inspector. ~ ~ - , Bulldm'~ Inspector/ Approved ........................................ , TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERKJ$ OFFICE SOUTHOLD, N. Y. ,9.2? ............................ App,co,on ............. APPLICATION FOR BUILDING PERMIT .......... ...... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with 3 sate 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 or areas, and giving a detailed description of layout ofproperty must be drown 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 Building Inspector will issue o 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 a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the i~suonce of a Building Permit pursuant to the Building 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 applicant 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 inspectior~. (Signatur0 of applicant, or nome, if a corporation) (Address of applicant) li7 t~6 State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ....~../..~E. xt~......~.~.~.~./~...~.C~/(/.~..//../ ..................................................................... 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 Zrade's License No ............................................... 1. Location of land on whic~,pro, posed~~~~work will be done. Map No.: ....... ~ ......... ~_~ot No....~.~. Street and Number .. ~F..,iJ=~;i~f~./~C'~~~..- 2. State existing use and occupancy of premises and in.~ended use and occupancy of proposed construction: Exisiting use and occupancy ..............~..~ ................................. , .......................................... Repair .................. Removal .................. areal'tie ..................... Other Work ~..~/'~...~,~....~ ...... L/(DeJ,~ription) 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 ........ .,,.~ ......... :......, .......................... Rear ................................... ~ ...... Depth., ............................. Date of Purchase .......... ~/'~...~.....~...~..~.. ......................... ,,~~ __~'~ame ,of Former Owner "J~,~ _ r/ .,~- ................... Zone or use district in which premises ore situated .J[.~,~J~...~.....~ ~'~f.~4~¢~~ ......... 11. 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 3. Will 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 ....................... Nome of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly ali buildings, whether existing or proposed, and indicate oil set-bock 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.~O~// I S S COUNTY ........ //! (N~"~"~":'":~ualu,.~ ~..--~...~ signing contracf) being duly sworn, deposes and soys that he is the applicom obow.~ named. He is the ................................ ~.~ ............................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, end is duly authorized to perform or have per~ormed the said work and to make and file this application; that ail statements contained in this application are true to the best of his knowledge and belief; end that the work will be performed in the manner set forth in the application filed therewith. Swam to before me this ................. · '~..,. day of 19'Z.~... ....... .....~_ ~/~ .,~,~" ~/~ . Notary Public, ~ (Signature of applicant)