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Home My WebLink About7966-z FORM NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK ~UTHORIZED) 7966 Z Date ....................... ~a.Y....30. ............... 19..~..~. Permission is hereby granted to: ....... l~a~t~.tu~ ............................................... to ~..r..e..c...t.......a...n..d......m~.._.~....t..a...~......b.~...t...,~..t..~.e...k..a...a..,....~.e:a~ ~.ua..~a..~.~..~...~.~...E, ~., ...... at premises located at .... ,~O.~..~...p.~;.~..'J...~;~k,ff.~....~.o.c.o~$~...~l,~...~.t;..~ ............................ ............................................. ;[.~,ncl...V..'l.~. la. ~...Ba.ys~to~-e-.-P,d .......... C~:~ee,~per.'b .............. pursuant to application dated ................. J4a~' .......... ~0 ................. 19~.~ ....and approved by the Building Inspector. Fee $.1.~.~Q0. ........... FORM TOWN OF SOUTHOLD~''-. BUILDING DE PA RTMENT ' ~"~-~--.~. TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ......... t('-- '" ,-~' ..... 19...~..~Permit No, ..~..~.~ ~f ~ . Approved ........................................ , ....................... Application No..~.~.~....~ ........... Disapproved a/c~ ...... ~.....~ APPLICATION FOR BUILDING PERMIT Date ........ ~.....~...¢~. ....................... 19.~..,-~.. INSTRUCTIONS a This application must be completely filled in 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 adlammg 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 applicatic c The work covered by this apphcation may not be commenced before ~ssuance of Building Pertain d. Upon approval of this application, the Bu,ldmg Inspector wdl issue a Building Permit to the applicant 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 Cerhf,cate 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 Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describ: The applicant agrees to comply with all apphcable 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) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bull, 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 Trode's License No ............................................... /~ /n ,~, _ . ,a o ~ (]~ ~ff'~ ?'t$~ ~i,s'~ Location of land on which proposed wot;k will be do~e,~ /V p N .. ~..~. ......... ~ ................ Lot No/0. ................ Street and Number ..... ~.~...~ ....................................... ~~ ............. (_J ,~/ ~' Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction' o ........... ;.; ........ z/' ..... ;: ....... .............. ....... ''''''-'''' ............ b Intended use and occupancy ................................................................................................................... 3 Nature of work (check which applicable) New Budding .............. Add~tion ................. Alteration .......... Repair Removal Demolition. Other Work " ........ 4 Estimated Cost ........................................................... Fee ................................................................................... (to be pa~d on fihng thru apphcahon) 5. If dwelling, number of dwelling umts .......................... Number of dwelhng units 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 ...................... Rear ................................Depth ................. Height ........................ Number of Stones ............................................................................................................ D~mens~ons of same structure with alterations or addmons: Front .................................. Rear .................... Depth ................................Height .......................... Number of Stones ............................ 8 Dimensions of enhre new construchon: Front .................... · ............Rear ............................ Depth ................. Height ................... Number of Stones ....................................................................................................... Size of lot Front /-Z '/ Rear ?" ' ~ .... ............................................................................................... Depth Date of Purchase ...................................................... Name of Former Owner ...................................................... Zone or use distrmt m which premises are s~tuated .......................................................................................... Does proposed construcbon wolate any zoning law, ordinance or regulahon ........................................................ 13 Will lot be regraded ........................... Will excess fill be removed from p, rem, ises. ( ~. Yes ( ) No ]4 Name of Owner of premmes ........................................... ..~... Address ...... ~.....~ .................. Phone txlo ....................... Name of Architect .............................................Address ................................ Phone No ....................... Nome of Contractor ..................................... Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and &stinctly all bpdd~ngs, whether ex~sting or proposed, and In&cate all set-back dimensions fron property hnes Gwe street and block[number or descr~phon according to deed, and show street names and in&cate whether interior or corner lot STATE OF NEW Y~RI~,, ,, / I.¢ ~ COUNTY OF ...:~...:.'.;(~, ..C.J:~ ........ f .... (Name of indiwdual signing contract) above named. duly sworn, deposes and says that he ~s the apphcar (Contractor, agent, corporate officer, otc ) of said owner or owners, and ,s duly authorized to perform or have performed the so~d work and to make and fi this apphcotion; that all statements contained m thru apphcohon are true to the best of h~s knowledge and belief; ar thor the work will be performed in the manner set forth ~n the apphcation filed therewith. ~ - Sworn to before~me this ,~...;...'"2/";?day of '1~- / ~t ' ' ' .,- , .,- .... ';- .......... "'"y,. .....,, ....... · "' / Notary Public, ...2, .........................z¢.-, ............. ¢...~ C,,~unty ,' (S'gnotdre of apphcant) JUDITH T BOKEN Nc~tqF/' pU['hc, Stoic ¢.t New H@ .~,0344963 Suffolk C~_~ (~6f~,i~PsJJon Expires March 30,~5~