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Home My WebLink About7954-z FO]~ NO. 2 TOWN O~ $O~T~OL~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT CrHIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7954 Z Date .................... 19 Permission is hereby granted to: .... ,e~;,..~~./'.'~/e.'~.~~,,, / o~~,.:~~~.....~/~ .... / Building Ink.tot. Examined .......... ~..~..~.. ......... ' // Approved ........................................ , FO~M' NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. /- .... 19 ........ Permit No. D~sapproved a/c .......................... ~ ..................... ~/ ..................................... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a Th~s application must be completely ftlled tn b,y typewriter or' in ink and submitted in triplicate to the Buildir 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 adjo~mng premises or public streets, areas, and g~v,ng a detailed description of layout of property must be drawn on the diagram which is part of this applicatio, c. The work covered by this apphcatlon may not be commenced before ~ssuance of Building Permit. d Upon approval of this application, the Building Inspector will issue a Building Perm,t to the applicant Such perm 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 Occupan, 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 Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construct,on of buildings, additions or alterations, or for removal or demolition, as herein describe The apphcant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in buildings for necessary inspections. ........ -/ (Address of applicant) State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build.- ...................................................Name of owner of pre~..~x,~~...~ .............. ~ ................ .~.~..Z~'~ ........ '~'~'""~...~~'~ ........................................................................ ...................................... If applicant ~s 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 ............................................... 1 Location of land on wh~ch_~ro~g_osed wo~-4c'~vlll be done.. Map No · . ..................................Lot ~o .................... Street and Number ..~.b.~. ..... ~----~'~ ..~......~.4~. ........................... ~/.'~.4.~, ........... ~ ~Aunicipallty 2. State ex,sting use and occupancy of ~remises a~ 'mte.nc~ed use and occupancy of proposed construction: /d/Cc.,-./ 3. Nature of work (check which applicable) New Building ..~..'~..~.~ .... Addmon ................. Alteration ....... Repmr .................. Removal .................. Demoht~or. .......... Other Work ....... 4 Estimated Cost .................... ..~..~....~......~ ............ Fee~.~. c>~ ........ ii~'~'~il~'~i~n¥ ...... (to be pa~d on filing th~s application) 5. If dwelhng, number of dwelling umts ........................... Number of dwelhng umts on each floor ...................... if garage, number of cars ............... ;...;t:.z ......................................................................................................... 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 Stories .......................................................................................................... D~mens~ons of same structure with alterations or addmons Front .................................... Rear ....................... Depth .............................. Height ....................... ._~, ~.Number of Stones ................~, ............ 8 D,mensions of ent, re new construct,on. Front ............ .7....,.X .............. Rear .........'/.. ............... Depth ../...~...~.. ...... l-lmght ............... Number of Stories ...... '"'=~ 9 S,ze of lot' Front ......... I..~..~.~..~ .............................. Rear .......... I..~..~ ..................... Depth .... ~.~.~. ............. 10 Date of Purchase '" Name of Former Owner ......... .~.~:,, ..................................... 11. Zone or use district m which premises are s~tuated .................. .~....~.. .............................................................. 12 Does proposed construchon violate any zoning law, ordinance or regulation: .......... ~.; ....................................... 13 W~II lot be regraded ........................ Wdl excess fill be removed from premises: ( ) Yes t~) 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 d~stmctly all buildings, whether ex~sting or proposed, and red,cate all set-back dimensions fron property lines G~ve street and block number or descnpt~on according to deed, and show street names and ind~cat whether interior or corner lot STATE OF NEW Y.~'RK./.~/~,/~'~ S COUNTY s ........................................................................................ being duly sworn, deposes and soys that he is the apphca~ (Name of individual s~gning contracf) above named He ~s the .................................................................................................................................................................. (Contractor, agent, corporate officer, etc ) of sa~d owner or owners, and ~s duty authorized to perform or have performed the sa~d work and to make and th~s application; that all statements contained m this apphcatlon are true to the best of his knowledge and behef; an that the work will be performed ~n the manner set fo~h m the apphcation filed therewith. Sworn~o before me this . .... of ............. ....... , ...... ....... ............ ........... (Signature JU~I~'T ~' e,~ ~ Com~ ~p~res March 30~