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Home My WebLink About7991-z FOI~M NO. 2 TOWN OF SOfT,OLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTItOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 7991 Z / to ~'/t/z-- 7 6 J Date ......................................................... 19 ........ Permission is hereby granted 1o: ~..¢$?.~.~..!?. ............ ~?..! ........ _.~....~...L.~.~. .......... pursuant to application doted ............................ .~..~.~'./.~ ........ ~.!.~.., 19Z?...-~, ond approved by the Building Inspector. Fee ~ ..... ./.~ .......... Building Inspector Examined l~Oll~ ~0. ! TOWN ~DF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTIHOLD, N. Y. Approved ........................................ , ]9 ........ Permit No ..................................... Disapproved o/c ~ ' ................................. ;~ ...... ~-.~ ................. , (/ :? ,' _ .'. (Building Inspector) AFFLIGATION FOR BUILDING PERMIT INSTRUCTIONS a. Th~s apphcat~on must be completely filled in by typewriter or ,n ink and submitted in triplicate to the Buildin. Inspector, with 3 sets of plans, accurate plot plan to scal,e. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets o areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which ~s part of this applicotior c. The work covered by th~s apphcation may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Budding In.~pector will issue a Budding Permit to the applicant. Such permi shall be kept on the premises available for inspection throughout the work. e No building shall be occupied or used in whole or irJ 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 c Regulations, for the construction of buildings, additions cr alterations, ar for removal or demolition, as herein describe, The applicant agrees to comply with all applicable 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) (Address of applicant) State whether applicant is ~er,~)lessee, agent, architect, engineer, general contractor, electrician, plumber or buHde~ / ................ : ............ ..'~ ........................................................................................................................................................ Name of owner of premises .......... : ..... :..,; .......................... ' ..... '. ..................... [~. ......................................................... i% .... If apphcant is a corporate, s~gnoture of duly authorized officer. (Name and title of corporate ofhcer) Builder's License No ......... ,..x..~ ............. ,..,. ............ Plumber's bcense No ...................... .?..: ........... ~ .......... Electrician's License No ............................................ Other Trade's License No ............................................... 1 Lacahon of land on wMch proposed work will be done. Map No .................................. Lot No ....................... Street and Number .............. [...z....~ ....... :.../.J...~..'....'.....' ..... :..J ..................... ::...; .................................................. Municipality 2. State exishng use and occupancy of premises anc intended use and occupancy of proposed construchon: a Exmlting use and occupancy ................. : ............ ~,. ~.; ..... ;..; .......... ./..'. ~.....~./.../. ................................................... b. Intended use ond occuponcy ........................................ - ......................... / .................................................. 3 Nature of work (c~heck which apphcable) New Budding ................. Addmon ............... Alteration ............ Repmr ................. Removal ................. Demoht or ........... Other Work ........................................... -'~ (Description) // f,',._" 4 Estimated Cost ....................................................... Fee ............................................................................. (to be paid on filing this application) 5. If dwelhng, number of dwelling 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 D~mens~ons of existing structures, if any' Front ................... Rear ................................Depth ................ Height ........................ Number of Star,es .................................................................................................... D~mens~ons of same structure with alterations or ctdd~hons. Front ................................. Rear ................. / Depth ............................... Hmght .................... Number of Stories ............................... ! , 8 D~menslons of enDre new construcbon Front .............. , .............. Rear ...........................Depth ................. He,ght ................... Number of, Sttorl?s ................................................................................... ~ ....... 9 S~ze of lot. Front .......... 7.~/, ............ ~.;. r~/. .......Rear ........................................ Dept~ ................. 7"?'""~"' 10 Date of Purchase ........................................... :~ ..... Name of Former Owner ....................................................... 1 1. Zone or use d~stnct in which premises are situated ....................................................................................... ]2 Does proposed construction wolate any zomng law, ord,nance or regulation 13 Will lot be regraded ........................... Will excess fill be removed from premises: ( ) Yes ( ) N~o 14 Name of Owner of premises .................................................. Address ................................ Phone No ....................... Name of Architect .... ~? ..... ~ ...................... Address ................................ Phone No ....................... Nome of Contractor ................................... Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and d~sbnctly all buildings, whether ex~stmg or proposed, and red,cate all set-back d~mens~ons frorn property lines Gwe street and block number or descnpt~on according to deed, and show street names and indicate whether m~.erlor or corner lot _-rATE OF COUNTY..1 ,r OF ........ ........ ' '" being duly'~worn, deposes and says that he ~s the opphcanl (Name of individual signing contract) above named. He is the ..................................... ~ ..................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and ~s duly authorized to perform or have performed the sa~d work and to make and f~le this application; that all statements contained in thru apphcation are true to the best of his knowledge and behef, and that the work w~ll be performed ~n the manner set forth in the application filed therewith. Sworn to before me this ........................ day of ................................. , 1~,. .... NCbry~ Public, . .......... .~.-¢ .............. ~,:~ ................... County .......................................................................................... ~.~'/./., ~. / ~/~i.~/~ j~ .,.~,~,__ (S,gnoture of applicant) No T~m'ExpJres ~a~ch 30, tg~