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Home My WebLink About7972-z FOR~ NO. 2 TOWN OF $OUT~OLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT CI'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7972 Z Permissios? is hereby granted to: ..... ~.oh¢ r.J;.. Adlple.~.o. .................................. ............. P.e. coni~ ................................................ to ...~:ne~+,;...:['e~,c ftn~..~u..-~.ee~...~a~'~..~z~e~ ........................................................................... at premises located at ..... w~./~...pe~o~:i¢....~.~crie..%,...4.~.I..~.~.~.~{.:.,. ...................................................... ..................................................... [!..c~m~.c ..... N..~ ............................................................................ pursuant to application dated ............... uT32~3~..~, ......................... , ]9.~..~.., and approved by the Building Inspector. Fee $,.1. ~....p. ,0, ........... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. APPLICATION FOR BUILDING PERMIT Date ~ ~- - , 19 ..... i ...... INSTRUCTIONS a. Th~s apphcat~on must be completely filled in by typewnter or An ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing locahon of lot and of buddings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this application. c The work covered by this apphcation may not be commenced before ~ssuance of Building Permit. d Upon approval of th~s application, the Building Inspector will ~ssue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e No budding shall be occupied or used in whole or in part for any purpose whatever unhl 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 Bu~tdmg Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterahons, 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 i~ buildings for necessary inspections. ,~ (Signature of apphcant, or name, if a corporation) (Address of applicant) State whether applicant ~s owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Nome of owner of premises ..... . .~_~.~....~ ............................................................... 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 Trade's License No ............................................... 1 Location afl ' h h d k I1' d Ma ' / ~ L t' o aha on w ic pj~c~se war wi De one. p ~ .................. ~ .... o ~N ..... ~ ................. Street and Number ....... ~.~...~...:...~.~....~C--~.~..~.~../....~-: ............ ~...~....c~._~ .................... Municipality 2 State existing use and occupancy of premises and ~n:ended use and occupancy of proposed construchon: a Ex,siting use and occupancy ............................................................................................................. b. Intended use and occupancy .............. .~...'~...k_~...~ .............................................................................. 3 Nature of work (check which applicable) New Budding ........... Addition ................. Alteration Repair .................. Removal ................ Demolmor ............ Other Work .............................................. (Description) 4 ~timated Cost ....................................................... Fee ../. ....................................................................... (to be pa~d on filing this apphcahon) 5 If dwelhng, number of dwelhng umts ....................... Number of dwelhng 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 Dimensions of exmtmg structures, if any: Front ..................... Rear ............................... Depth ................... Height ........................ Number of Storms ................................................................................................ D~mens~ons of same structure with alterations or addmons Front .................................... Rear ................... Depth ................................ Height .....................Number of Stories .............................. 8 D~mens~ons of entire new construction: Front ................. , ............... Rear ............................ Depth ................ Height ................... Number of Stones .............................................................................. 9 Size of lot' Front .................................................... Rear ................................... Depth .............................. 10 Date of Purchase ....................................................... Name of Former Owner ....................................................... 11. Zone or use distr~ct in which premises are situated .................................................................................... 12 Does proposed construction v~olate any zomng law, ordinance or regulahon ........................................................ 13 W~II lot be regraded .......................Wdl excess fill be removed from premises: ( ) Yes ( ) 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~st~nctly all buddings, whether ex~stmg or proposed, and md~cate all set-back d~mens~on$ from propcrty hnes Gwe street and block number or descnphon according to deed, and show street names and indicate whether intenor or corner lot STATE OF NEV~'"Y~,Ib COUNTY OF .~.~.,.~)'~.~.. ........ ~..~ ..................... ~....~...~...~'~../...~.....~...~....~...~.~....~. ............. be,ng duly sworn, deposes and says that he ,s the opphcor (Name of redly,dual s~gning contracf) above named He ~s the ......... (Contractor, agent, corporate officer, etc ) of sa~d owner or owners, and Is duly authorized to perform or hova performed the sa~d work and to make and th~s apphcot~on, that all statements contained ~n thru apphcahon are true to the best of h~s knowledge and behef; tha~ the work will be performed in the manner set fo~h m the apphcation filed therewith. Sword to before me this ~ .~ / ..... ......... of ....... ................. , .................... ...... ................................. .:. ...................... .............. ELIZAB~T~ NOTARY PUBLIC, S~te of New York ~o 52 8125850, Sull~lk Term E~mre~ ~reh