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Home My WebLink About9268-z FORM NO. 2 TOWN OF $OUTHOL~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. L BUILDING PERMIT 9268 (THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL COMPLE'I'ION OF THE WORK AUTHORIZED) Z Date ......................... ~.~.,....3.~ ............... 19...7.~. Permission is hereby granted to: .................... .8o~.',~o~.a ..................................... to .~'~;...~_O,..~a.t~ ~..bJ~.~..~£c~.~.. ~'e~;c ~'~...e~..~,e~.. ~.p~e~ ~..~3~./77 at premises located at ..iJ~(~l)~et~..~3~.eL~k..-3_.~_~l~ .................................................................................. .............................................. ~o~t~ ....... 1~. ............... : .............................................................. pursuant·. ~, . ._., ~,~-t° application. _.~ ...... dated '":"~'7.' ......... : ........ l~y.---.-~$ ...... ;...., ]9..TJ/.., and approved by the Building Inspector. ............ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERIC'S OFFICE SOUTHOLD, H. Y. ................ ....... , ,o. ....... A,PLI D,te:......~....~.?..~:. ........................ , INSTRUCTIONS a. This application must be completely filled in by typewriter 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 premises, relationship to adjoining premises or public streets, areas, and gwmg a deta,led description of layout ofproperty must be drawn on the d~agram which is part of this applicatio, c. The work covered by this application may not be commenced before issuance of Build,ng Permit. d. Upon approval of this application, the Building Inspector will issue a Budding 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 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 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 admit authorized inspectors on premises and ir~ buildings for necessa_ry ........ ................ (Signature of applicant, or /~6me, if a co~oration) ............................... ...................... State whether opphcant ts owner, lessee, agent, architect, engineer, general contractor, electricton, plumber or budde Nome of owner of premises ........................... ; ..................................................................... y. ......................................... If applicant ts a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. P[umber's License No ................................................. Electrician's License No ............................................. Other Trode's License No ............... ..,/~..~ ................... 1. Location of land on which proposed work will be done. Map No.' ..................................... Lot No ....................... Street and Number ~..~tfA,~ ....... ~' ./~.~.~.~.,~ ............. ~.,4t.//.,~,. .......... ~~ ....... ...... 2. State existing use and occupancy of prem~ and intended use and occupancy of proposed construchon: a Exisiting use and ~cupancy ............................................................................................................................ b Intended uso ~nd occupancy ......... ,~...~ ....... &~ .................... ~z ........................................ Nature of work (check which applicable) New BuHdmg .................. Addihon .................. Alteration ............ Repair .................. Removal .............. Demolihor ................... Other Work (Description) 4. Estimated Cost .......... ./.~[r~..~.~ .............................. Fee ...................... (to be paM on filing thru apphcat~on) 5 If dwelhng, number of dwelling umts ..................... Number of dwelhng units on each floor ......................... If garage, number of cars .............................................................................................................................. 6 If busmess, commercml or m~xed occupancy, specify nature and extent of each type of use ......................... 7. Dimensions of ex~stmg structures, ff any. Front ...... .~..~ ............... Rear ...... ~..!. .................... Depth ..5:.~..~ ....... Hmght ........................ Number of Stories ..................................................................................................... D~mensJons of same structure with olterahons or addmons Front .................................... Rear ..................... Depth .............................. Height ........................ Number of Stories ............................ 8 D~mens~ons of enhre new construction' Front ...... .../~.~ ............... Rear ............................ Depth ................... Height ................. Number of Stones ...................................................................................................... 9 S,ze of lot- 'Front ........... /.,~...'~.. ............................. Rear .../...'~.~.. .......................... Depth ...'~..../....~. ................ 10. Date of Purchase ........... /...~...~.~ ............................ Nam,,~ of Form, er Owner ...................................................... 11 Zone or use d~stnct m which premises ore situated . .. ,~/........~.'..g;.~ .~...~....~....t../.~....~. ................................................ 12 Does proposed construchon wolate any Tatung Iow, ordinance or regulahon ..... ~..~.. ..................................... 13 W~II lot be regraded ....................... aJ//~'O Will excess fill be removed from premises: ( ) Yes ( ) No 14 Name of Owner of premises ................................................. Address ................................ Phone No ..................... Name of Architect ......................................................... Address ................................ Phone No ..................... Nome of Contractor ................................................. Address ................................ Phone No ..................... PLOT DIA(~RAM Locate clearly and d~stmctly all buHdmgs, whether ex~st~ng or proposed, and mdmate all set-back dimensions fro property hnes Gwe street and block number or descnphon occordmg to deed, and show street names and indica whether mtenor or corner lot STATE OF NEW YORK, COU ~JTYJ OF ........... .S 'C .......... ................................................................................... bemg duly sworn, deposes and says that he ~s the appho (Nome of md~wdual s~gning contract) above named ~ ~.~ He ~s the ............................................................................................................................................................ (Contractor, agent, corporate officer, etc of sam owner or owners, and ~s duly authorized to perform or have performed the said work and to make and this application, that all statements contmned m th~s appl~cohon are true to the best of his knowledge and behef; , tha~ the work wdt be performed m the manner set fo~h in the apphcation filed therew~th~ Sworn to before me th~s , -' ...... ..... of .... ................ , ' . ~ /j ~ ........ ~..~ .... ~..~ .................... ~oun~ ............... ~,~.~ .................. ~ ...................... .y ................ ~/~. ~ [ ) ~' (S~gnmture 5f applicant) % [ ~ MARY ~ ~Y PUBLIC, State of New Yor~ NO. 52.464372[~ Suff~ Co~