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Home My WebLink About7962-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 PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7962 Z Permission is hereby gronted to: Jeael~h...pa.tke ............................................... .... 1+7-.~:~ ...... 11-7.~h...~ ..................................... .............. W.~o~side.....l~.t· ..... 1.1.3~. ........... to b~ ~rl ..atl..&d~i~zLo~..cm..ex~st~n~..cl.~el.t.~g ................................................................ at premises located at .Lo.t..2.~z..}3....Q:eelz1~or.t..~ho=o~ ....................................................... ...................................................... Bho~e..~ri.wa .......... O~.ee~npor..t ....... L..L~ .............................. pursuont to cpplicotion doted ..................... Ma~:.....1.~ .................. , 19..~..~., cnd opproved by the Building Inspector. Fee $1 ~...O.(~ ............ Approved ........................................, FOI~M NO. I TOI,VN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. .emit .......... Application No.....~..f...~'..~ ...... Disapproved a/c ...... .~..~....~ (~uflding Inspector) / APPLICATION FOR BUILDING PERMIT Date ...............J~f~lr..]l, ~ ................... , 19...?.~... INSTRUCTIONS a This application must be completely filled ,n by typewriter or in ink and submitted in triplicate to the Buildi, 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 areas, and giving a detailed description of layout of property must be drawn on the diagram which ~s part of this apphcatio c The work covered by this apphcation may not be commenced before issuance of Building Permit d Upon approval of th~s apphcatlon, the Building Inspector wdl issue a Building Permit to the apphcant. Such pern 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 t! Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or aJteranons, or for re~dvol or demolition, as herein descnb, The applicant 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. (Signature of applicant, or name, if a corporation) (Address of applicant) 11377 State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build Name of owner of premises ./~.~....~...~...Z~.. ~:~...~*~ ............................................ If applicant is a corporate, ~)~nature 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 ...............................................~/! ~_~ $I.;~:--JL ~ 1 Location of land on wh,ch prop_ose~d work wi, JJ. be done. Map No ~~3L. ot No..c--'~T......-C....~.. ..... Street and Number ........... ~...~ ................ ~..~..,~,.-..../.: ........................ Municipality 2 State ex~shng use and occupancy of p/r~mises and imended use and occupancy of proposed construchon' a Ex,siting use and occupancy ............... :.: ......... ..~ ~~.~..~.~ ~ ...... ~..~ ............ b. intended use and occupancy .................................................................................................................... 3. Nature of work (check which apphcable): New Bud&ng ................ Addit,on ...... ~ .........Alteration ........... Repair ................. Removal .................. Demolmor. ...............Other Work ............................................... · J' d~0 (Description) 4 Estimated Cost ........ ~.~. ~ .0.0..~ ...................................... Fee ........~,~:O'J~.....I..~..;: ...... 'i ......................................... (to be paid on fihng th~s apphcat~on) 5. If dwelhng, number of dwelling units ........................... Number of dwelling un,ts on each floor ........................ If garage, number of cars .............................................................................................................................. 6. If bus~ness, commercial or re,xed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any. Front ...... Y~(~!. ............. Rear ........ ~.~J. .................. Depth ..... ~g!. ........ Height ...... .Z..0..t ........... Number of Stones ............... [ ................................................................................. .. ........ D~mensions of same structure with alterations or addmons Front .......... .Y~J. ................... Rear ........ ~{~.~ ........ Depth ........ ~.Z..'. .................. Hmght ......................... Number of Stones .............................. 8 Dimens,ons of entire new construction- Front ................................... Rear ....... ].6.! ............... Depth ...... 1~.! ...... Hmght .................. Number of Stories .......................................................................................................... 9 Size of lot' Front ........... .7.5.! .................................... Rear ......... 75.! ........................Depth ..... 12. q.t ................... 10 Date of Purchase ........ ~.V,,1.y...],~.., .~.~.~.~. ............... Name of Former Owner .... ~T,...O~fx~h~ ......................... 11 Zone or use district in which premises are situated .............................................................................................. 12 Does proposed construction violate any zoning law, ordnance or regulation' ......~.~ ............................................. 13. Wdl lot be regraded ............. ~ .......... Will excess fill be rer~Qved_from p_remises:?f.~ ~, ( ) Yes ( ) No ]4 Name of Owner of premises .... .~.,.. Name of Arch,tect .................................................. Address ................................ Phone No ....................... Name of Contractor ................................................... Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and dmtmctly all buddmgs, whether emstmg or proposed, and re&cate all set-back dimensions from property lines Gwe street and block number or description accordmg to deed, and show street names and indicate whether mtenor or corner lot STATE OF NEW YORK. ~ c S COUNTY OF ........................... f~' ....... ~....~.{...~ .................................... being duly sworn, deposes and says that he is the apphcanl v '(Nome of }nd,v,duol signing contract0 above named. He ,s the ........... ~ ....... ' ........................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the sa~d work and to make and file this appl,cotion, that all statements contained in th,s apphcat,on are true to the best of his knowledge and behef; and thru the work wdl be performed ,n the manner set forth ,n the appl,cation filed therewith Sworn to before me this ........... ..... .................... ,. ..... , , , . co= .................. .......................... ~/~~ .... (Signature of applicant)