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Home My WebLink About9194-z FO~,~ NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILI~ING PERMIT (THIS PERMIT MUST BE KEPT ON THE P]~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9194 z Permission is hereby grante~d, to: ~'~ ~ ;-~ "af i~r~ntises [mated at ..~.~.g..~l~,~,t~ .-1~;:~.....(....~'~...~..t~..~l~l~pp ..*e~ll~t~ ................ 31icetion aeted .................... ; .......... ~...: ...... ~, end opproved by the FOlY.~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exam,ned ....... ~.....~.~ ....... 1 ~?..?... Approved .................. :J ......... I..~. ...... , 19.?...~. Permit No ...... .?..~...?....¥.,....~... ........ Disapproved a/c ............................................................................................ Application No...?.(.?....~.. ............. (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by Wpewriter 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 premfses, relationship to adjoining premises or public streets ~ areas, and gwing a detailed description of layout ofproperty must be drawn on the d~agram which is part of thfs applicatio, c. The work covered by th~s apphcation may not be commenced before issuance of Budding Permit. d Upon approval of this application, the Building Inspector will issue a Building Permit to the apphcant. 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 Occupan, shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department far the issuance of a Building Permit pursuant to ti- Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances, Regulahons, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe, The apphcant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and t admit authorized inspectors on premises and ir~ buildings for necessary inspections. (Signature of applicant, or name, if a corporation) ....... ............... (Address of applicant) State whether apphcant ts owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or buiide Name of owner of premises ~ ~ ~ ~:~/W- ~' ~'~ If applicant.As a corporate, signgture of duly authorized officer. .......... Builder's Ltcense No. (~-~L.~ Plumber's License No ................................................ Electrician's License No ............................................. Other Trade's License No ............................................... ~ ~ 1 Location of land on which proposed wdl be done Map No Lot No Street and Number '-~.~--~- ~. ~-~.ii.i.~.ii~.'~__.~~iii Municipality 2. State existing use and accupancy of premises and in~ended use and occupancy of proposed construction' a Exisit,ng use and ~cupancy ~~~ ~~j ~ ....... ........ ......................... 3. Nature of work (check which applicable). New Building ................. Addition ................ Alteration .......... Repair ................. Removal .................. Demolition ................. Other Work .................................................. t ~'/ ~ (Description) 4 Estimated Cost ........................................................... Fee ..................................................................................... (to be paid on fihng thru application) 5. If dwelh~g, number of dwelling units ..........................Number of dwelling umts on each floor ......................... If garage, number of cars ................................. 6. If business, commercml or m~xed occupancy, specify nature and extent of each type of use 7 Dimenmons of existing structures, ,f any: Front .........................Rear ................................ Depth .................... Hmght ........................ Number of Stones ........................................................................................................ Dm~enmons of same structure with alterations or addmons: Front .................................... Rear ...................... Depth ............................... Height ........................... Number of Stories .............................. 8 D~mensions of ent, re new, construction. Front ................... , ................ Rear ............................ Depth .................... Height .................Number of Stories ........................................................................................................ 9. S~ze of lot' Front ........................................................ Rear .......................................... Depth ............................. 10. Date of Purchase ....................................................... Name of Farmer Owner ...................................................... 11. Zone or use distnct m which premises are s~tuated ............................................................................................. 12 Does proposed construction wolate any zomng law, ordinance or regulation' . ..................................................... 13 WIll lot be regraded ............................ Will 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 distinctly all buildings, whether ex~stmg or proposed, and red,cate oil set-back dimenmons fror property hnes. Gwe street and block number or descriphon accordtng to deed, and show street names and indicat whether interior or corner lot STATE OF NEW~,'~,Cigi~, ~ c c COUNTY aP .... .'..'? .t t.~.~:: ........... f ~ '~ ............................................................................................. being duly sworn, deposes and says that he ~s the apphcar (Name of individual signing contracf) above named. ~ lessee He is the (Contractor, agent, corporate officer, etc.) of sa~d owner or owners, and is duly authorized to perform or have performed the sa~d work and to make and fd this application; that all statements cantamed in thts application are true to the best of his knowledge and belief; an that the work will be performed in the manner set fo~h in the apphcation filed therewith. Sworn to before me this , 19th day of April 19.77 Su~fo~ Nota~ Public, . ............ .~ ........... ~; ................. CounW ~~, ,r ~4~-~'~f~ (Signature of applicant)