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Home My WebLink About7979-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 COA4PLETION OF THE WORK AUTHORIZED) N? 7979 Z Permission is hereby granted to: .................. ~.~coa.tc .......................................... to .h~_~_!d..an.,ar~ d~tia~..o~..e~i~t ~g.. dw~.Ltng...~e~k&~g.. &...wa3,L--~a.~s.) ............ at premises located at ..... ~.$..~.CLdd-_-'t=,:, ..Eu~.. (C,~2,7) .................................................................. Peconie N,Y. pursuanf to application d~ted .................... ~..l~e ...... .~. ................ , ]~.~.~.., and ~pproved hy the Building Inspector. Fee $..1.5.e. Qg. .......... FOn, M b~O. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ....... s:l ........ ?..Z...7. ............ pro ed ........ ........ ........ , No. ...... D,soppro ed ....... ~P~I.I~ATION ~OR BUILDIN~ PER/~IT Date .... ..,l....O..~.~....f. ......................... , ~¢.Z.~. INSTRUCTIONS a. Thss application must be completely filled in by 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 build,ngs on premises, relationship to adjoining premises or public streets, areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of th~s applicatiof c The work covered by this application may not be commenced before issuance of Building Permit. d Upon approval of this application, the Building Inspector wdl ~ssue a Building Permit 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 Occupanc 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 th 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 alterations, or for removal or demohtton, os herein describe, The applicant agrees to comply with all apphcable laws, ordinances, building code, housing code, and regulations, and t admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) (Addr~"s~f applicant) State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or buildei ...................... .~..~..~.~.~. .................................................................................................................................................... Nome of owner of premises ............ .~..g..~....~....~...l). ........ fi.:, .../-/.</~...t~,..~...~. ............................................................. If applicant is a co~orate, 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 whmch proposed work will be done. Mcp No ................................ Lot No .................. Street and Number .......... /g....~.. ......... ~,.~..:.~.~..1~. .......................................... .~.~.~.. ........ 'Municipality' ...................... 2 State existing use and occupancy of premises and intended use and occupancy of proposed construction: a Exisltlng use and occupancy ....... I~,..~J. ~'./.. ~ ./....~.'. ~ ................................................................................... use and occupancy ...... 6(..,,4/L4.£.,~,./..(.~u.~ ............................................................................................. b Intended / 3. Nature of work (check which applicable). New Building ............... Addition .....~ ....... Alteration ......... Repair ......... ~ ....... Removal .................Demoht~or. ~ Other Work (Description) 4. Estimated Cost ...... ,~. .................................................. rue .................................................................................... (to be pa~d on filing thru apphcation) ~ , 5 If dwelling, number of dwelhng units ....... ~ ............... Number of dwelhng umts on each floor .......................... If garage, number of cars ...................................................................................................................................... 6. If business, commercial or m~xed occupancy, spec,fy nature and extent of each type of use ........................ 7 Dimensions of exmt,ng structures, if any: Front ..... ,.~.~.....~'.. ......... Rear ................................ Depth ..~.-Y.....ff.. ...... Height ........................ Number of Stories ......................................................................................................... D~mensions of same structure with alterations or addmons Front ...~..~.../.?./..~: .................. Rear .................... Depth ....~./..O.f.....Z.l...~.~ ......... He,ght .....................Number of Stories .............................. 8 Dimens,ons of ent,re new construct,on: Front ...~,..~..~...~..,~.~ .............. Rear ........................... Depth ....................... Height ................... Number of Stories ................~.. ?.....~.. ...... I~...~ ¢.~ ............................................................ 9 Size of lot' Front ....................................................... Rear ........................................ Depth ............................... 10 Date of Purchase ..................................................... Name of Former Owner ..................................................... 11 Zone or use district ~n which premises are s~tuated ............................................................................................... 12 Does proposed construction violate any zoning law, ordinance or regulation ........................................................ 13 Wdl lot be regraded ........................... Wdl excess fdl 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 distinctly all buddings, whether ex~sting or proposed, and md~cate all set-back d~mens~ons fron property hnes Gwe street and block number or description according to deed, and show street names and in&cat~ whether interior or corner lot STATE OF NEWr~DIg'IF~, /~r ISS COUNTY OF .~J~.'~/l~.c.L...:....z...~' ..................... "~'"O~""/Li-~"~"'"'"~'" .......~'1 ................ be,ng duly sworn, deposes and says that he ,s the apphca; (Nam~'Sf indwidudl sigmng contrac above named He ,s the ...................................... ..~ff.~.~..]......./.. '.~ ........................................................................ (Contractor, agent, corporate officer, otc ) of sa~d owner or owners, and is duly authorized to perform or have performed the said work and to make and fi this application; that all statements contained ~n th~s apphcetron are true to the best of his knowledge and behef; thor the work wdl be performed ~r~the manner set forth in the application filed therewith Sworn to before me this / ................... ff. o o, ....... Notary Pubhc, . ................. ~~/(.Z ....... County ../...::..I.~ .................................................. .¥.....= ................... ~ -_-'-' ~/..~rr-"' t / (Signature of applicanf) }NOTAry PUBLIC e,