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Home My WebLink About7917-z FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 7917 Z Date ................. ...l~..~.. ....... ~ ................... , Permission is hereby granted to: , ..,..~..,.:..~.~...~.. ~.~.~ ....................................... ~a...~..... ~.o...t.~....o.~,..~~.~;L... ~.~, .............................................................. pursuant to application dated ......................J~$~k....,~O. .........., 19...~/.~, and approved by the Building Inspector, Fee $.~J~ J~t' ........... Building Inspectc~ TOW, N OF SOUTHOLD~ /~.~.~ /~.~t ~- ~ ~..,., BUILDING DEPARTMEN~~-c~' TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ Disapproved a/c ....~..._...._~.... ........... ... ............ APPLICATION FOR BUILDING PERMIT Application No. ?....~.../...Z ............... INSTRUCTIONS a Th~s application must be completely filled in by typewriter or m ink and subm,tted 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 or areas, and giwng a detailed description of layout of property must be drawn on the diagram which is part of th~s apphcation. c. The work covered by this application may not be commenced before issuance of Building Permit. d Upon approval of this opphcat~on, the Building Inspector will ~ssue a Budding Perm,t to the applicant. Such perm:t 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 Budding 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 apphcant 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. .... ~.assee ................................................................................................................................................................. Name of owner of premises ..~.9.~.~d~k~.~...A.q~..~.~.~'.~.~...Z~fl ............................................................................... If appJkcant i~ a corporate, s~anature ~of duly authorized officer. (,~ ' (Name and t~tle of corpor~[e officer) Builder's License No ..................................................... Plumber's L~cense No ................................................. Electrician's License No ............................................ Other Trade's License No ............................................... 1 Location of land on which proposed work will be done. Map No ................................ Lot No ........................ Street and Number ............................................................................................................................................. Municipality 2 State existing use and occupancy of premises and intended use and occupancy af proposed construct,on' a Exisiting use and occupancy .....~.P,~'.~.g.~,~g~.~..~e.s. ec~.T'.OT~ ........................................................................... b Intended use and accupancy ...... ~.~...~..e. ........................................................................................................ J 3. Nature of work (check which applicable). New Budding ....... ~ ..... Addition ................ Alteration ........... Repair ............... Removal .................Demoht~or. ............... Other Work ................................................. (Description) 4 Estimated Cost .... .~.~ ~.~.0.. :.~.0.. .................................... Fee . / ~....:~ ......................................................... (to be pa~d on filing th~s apphcation) 5. If dwelhng, number of dwelhng units .......................... Number of dwelling 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 D~mens~ons of exmtmg structures, ~f any: Front ..... 2.L~~. ................ Rear ..... 2.~. ...................... Depth ...~....~. ......... Height ].~.I. .................. Number of Stories ..1 ........ D~mensions of same structure with alterahons or addmons: Front .................................... Rear ...................... Depth .............................. Height .................... Number of Storms ............................... 8. D,mensions of entire new construct,on: Front ..... .~...2..t ........................ Rear ...... ~.~ ............... Depth .~.~..~. .......... Height .~..0..~. ........... Number of Stories ......... ~ ................................................................................................ 9 S~ze of lot' Front ...~.20..~ ............................................ Rear .........8O.Q.! ..................... Depth .].~.Q0 .................... 11. Zone or use d~stnct in which premises are situated 22. A¢~,.e8 ..~!gt.!. l',i.~t..Z3'tcl.~.$.¢~a~ ...................... 12 Does proposed construction violate any zoning law, ordinance or regulation' .~.. ............................................. i .... 13. Wdl lot be regraded ........................... Wdl excess fill be removed from premises: ( ) Yes (.~) No Inc. 14 Name of Owner of premises ..... Address ........... Phone No.~..~.~.-..,~.0.~... Name of Architect ......................................... Address ................................ Phone No ...................... Name of Contractor ................................................ Address ................................ Phone No ...................... PLOT DIAGRAM Locate clearly and dmt,nctly all bu,ld,ngs, whether ex,sting or proposed, and md,cate all set-back d~mens,ons fron property hnes. G,ve street and block number or descnpt,on according to deed, and show street names and indicate- whether interior or corner lot ¢ -'~d'~¢ ~AY~ STATE OF NEW YC~Ki / ,~i [ S S COUNTY OF ...~, .~.....~ .... .~...O..~.~...~..,....?.~.O...q.~.~....~.~.., ............................................. be,ng duly sworn, deposes and says that he ,s the opphcan (Nome of mdlwdual signing contracf) above named. He ,s the ....... ~.or.~or.a.¢.6...0.f~.~.e~. ......................................................................................................................... (Contractor, agent, corporate officer, etc ) of said owner or owners, and is dufy authorized to perform or have performed the said work and to make and this application, that all statements contained ~n th~s apphcahon are true to the best of his knowledge and belief; an, that the work wdl be performed ~n the manner set forth m the opphcation filed therewith. Sworn to before me this~ _ // .......... /...-. ........ ...... .................. . Yl t ,, ",/,: , ............. ...... ................. /] // I ~ignarure or appdcant) / ~ / ~ ~'. OC,~t~ b' / ~hR¥ PUBLIC, State of New ~.~ J Residing In Suffolk County Clks. No 52-608668~