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Home My WebLink About9221-z -~ FORM NO. 2 TOWN OF S~UTHOLD ~ ~,UJ~II,,iG~ D~EJ~]A~TMENT T6WN CLErk'S OFFICE SOUTHOLD, N. Y. " ~UILDING PERMIT ~O~ST BE K~PT ON THE PI~EMISES UNTIL~FULL 6F' "l:h~ W~I~'AUTHORIZED) FO~,M NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ............ .... ........... Approved ........................................ 19 ........Permit No .................................... D,sapproved ~....~....~.....~....~ ............................................... Ziiiiiii iiiii ........................ APPLICATION FOR BUILDING PERMIT Date ............. ....~....~.~..~...~ .......... , 19.Z...~... INSTRUCTIONS a This apphcatian must be completely filled m by typewriter or in ink and submitted ~n triplicate to the Buildir Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plat pIan showing location of lot and af buildings on premises, relationship to adjoining prem,ses or public streets ~ areas, and g~vmg a detailed description of layout ofpraperty must be drawn on the diagram which is part of this applicatio, 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 a Building Permit to the apphcant. Such perm 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 until a Certificate of Occupan, 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 tk Budding 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 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 ir~ buildings for necessary inspections. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde ............ ....................... ..... ................................................................ Nome of owner of premises ....... ~..~.../...~....~...&..?..../~..~. ........ .7~.../~?.4...~...~...~.~:...?. .................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and t~tle 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 which proposed work will be done. M~p No ........................................ Lot No ..................... Street and Number ....................................... .../~..~/~?...~.. ........................................................................................ Municipality 2. State existing use and occupancy of premise.s and intended use and occupancy of proposed construction: a Exisiting use and occupancy /.2'/~//-'/~ ~ .~/./~ b. Intended use and occupancy ............................................................................................................................. 3 Nature of work (check which applicable) New Building ................. Addition .................. Alteration ................ Repa,r ............... Removal ....... Demoht~ar ................ Other Work ...... /~rc. ~ o . ~ (DeScription) - ................................................................... 4 Estimated Cost ........................................................ ~ee (to be paid on filing th~s application) 5. If dwelling, number of dwelhng umts ....................... Number of dwelling units 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 Dimensions of ex~stmg structures, ~f any: Front ....................... Rear ................................Depth ................... Height ........................ Number of Stones .............................................................................................................. D~mens~ons of same structure with alterations or additions: Front .................................... Rear ....................... Depth ............................. Height ................. Number of Stones ............................... 8 D~mens~ons of enhre new construchon' Front ................................... Rear ............................ Depth ...................... Height ................ Number of Stories .............................................................................................................. 9 S~ze of lot' Front .......................................... Rear ......................................... Depth ............................... 10. Date of Purchase .......................................... Name of Former Owner ....................................................... I 1 Zone or use d~stnct ~n which premises are s~tuated ............................................................................................. 12 Does proposed construction violate any zoning law, ordinance or regulahon: ....................................................... 13. W~II lot be regraded .................. : ...... .Will excess.fill be removed from premises: ( ) Yes ( ) No 14 Name of Owner of prem,ses .......................... ,..-...f. .................. Address~.r~t'..,.r.(.~...~,... .... Phone No ...................... Name of Architect ............................................. Address ................................Phone No ...................... ~ - - ~/c ~Z//t)~ /~/6/~-C~/Z/~ ,q Address~.~C.~X~.~D~f.~ ...... Phone No. Nome of L. on~rac~or .................................................................. PLOT DIAGRAM Locate dearly and d~stmctly all buildings, whether existing or proposed, and indicate all set-back dimensions fror property hnes G~ve street and block number or descnphon according to deed, and show street names and indicat whether intenor or corner lot STATE OF NEW YORK, ~c COUNTY OF ........................ ~-~S ..................................................................................... being duly sworn, deposes and says that he ~s the opphcar (Name of ind~wdual s~gning contract) above named He ~s the ............................................................................................................................................................... (Contractor, agent, corporate officer, etc ) of sa~d owner or owners, and ~s duly authorized to perform or have performed the said work and to make and f~l this apphcation, that all statements contained in this apphcation are true to the best of his knowledge and behef; an tshv~r tornhteoWb~rfkor~,lml eb~h~serforme~ ,n the manner set forth ,n the apphcat:on filed therewith.__ ' :u4 ............. -Z/j .... /~ . .. (Signature of applicant)