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Home My WebLink About9204-z FORM NO. 2 TOWN OF SOUTHOLD EUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. EUILDING PEP, MIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9204 Z Permission is hereby granted to: pursuant to application dated ..................... al~l~l, ......~.~ ......, 19.~..., and approved by the Building Inspector. F.. $.11:,~ ........... Building Inspector lrOB~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~OUTHOLD, N. Y. Examined ...... C~ ............ .~...~ 19..~....~. Approved ............... ~.~. ........ ..~.....~..L..., 19..?..~. Permit No...~....~....~....~....~ ........ Disapproved a/c ...................................... ~ (Building Inspector)/ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No....~.....'~....0...al .............. a. This application must be completely filled in by typewriter or' in 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 location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application. 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 will issue o Building Permit to the applicant. Such permit 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 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 Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, 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 in buildings for necessary inspections. .................................. (Signature oxf~licant,'~r name, if a corporation) ............ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..... ~;~i..i~.......Gb...~.4'~......'~.. ............L~/~~..~ ...................... 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 Zrade's License No ............................................... // 01.,// (~.n . Locat on of and on which proposed work will be done M~D No,' .. ~. I/~'~'~Lot t,J~ -/~ k Street and Number /~.~...~...~...~........~.'.~..~) ....... ~.~.~.'..O..i?~i~iiiiiiiiiiiii~i'~/iii'.~jL~.j~.i~,~iiiiiiiiiiiiiiiiiiii Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ........ ~ ....................................................................................... b. Intended use and occupancy ..................... ~..k. .............. ~...~.....~.....~....~...~r .......................................... 3. Nature of work (check which applicable): New Building,. ................. Addition .................. Alteration ................ ( __ .~/~ ~ (Description) F 4. Estimated East .............................. ~ ........................ee .......................................................................................... (to be peid on filing this epplicetion) 5. If dwelHng, number o~ dwelling units ............................ Number of dwelling units on eech floor ............................ If gemge, numSer of c~rs ............................................................................................................................................. & ff ~usiness, commerciel or mixed occupency, specify neture end extent of eech ~pe of use ............................ 7. Dimensions of existing structures, ff ~ny: Front ............................ Reer ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of seine structure with eltemtions or od~itions: Front ....................................Reef ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions o+ entire new construction: Front ....... ~. .................... Reer ...~.~: ................. Depth ...~ .............. Height .................... Humber o~ Stories ..................................................................................................................... ~0. Dete o~ Purchese ........................................................ N~me of Former Owner ........................................................ ] ]. Zone or use district in which premises ere situmed ..................................................................................................... ]2. Does proposed construction violate ~ny zoning IQw~ ordinence or regulation: ........................................................ 13. Will lot be regraded. ............ ~ ~~ .......... W~excess ~ill be removed f~i~:;~)~ ~, Yes ( ) No Mome of Architect .............................................................. Addross ................................ ~hon* ~o ....................... Nome of Contractor ............................................................ Addross ................................ ~hon~ ~o ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-~ck dimensions from prope~y lines. Give street and block number or description according to deed, and show street names and indicate ~hether interior or corner lot. STATE OF NEW Y.ORL¢. ,. I ¢ c COUNTY OF ....... .#~ .~..~..O...-'1~.- ........ ~erry L. Cor&zz£ni ................................................................................................ being duly sworn, deposes and says that he is the applicant (Name of individual signing contracf) above named· Re is the o,~mer (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that oil statements contained in this application are true to the best of his knowledge and belief; and thor the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this 22nd ~ , April ........................ aay aT ............................................ , m~ ........ · Suffolk Notary Publ,c .................................................... County ..~~.....>.~.~:. .................................... . ._.~ .; · (Signatu~e~Sf applicant) .._.-, ,,: / , _ ~d~IZABETH ANN NEVILLI~ NOTARY PUBLIC, State of New York