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Home My WebLink About9270-z FOBM NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTffOLD, N. Y. BUILDING PERMIT CTHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) N? 9270 Z Permission is hereby granted to: ~i~"FcrE"Fe~'cu"Co ....... ................ Be~..~..ve ......... l'~.%.t~uet~ .......... to..~ e~ ~. ~ .. ~a.t~.~...$er~.~ ~...a~...~ ~.. ~:~ [~.~ea.%! e~...~f~+/r~ .......................... at premises located at ...j~13~..~O~.T/..]~;[,~L~r8 ....... : ............................................................................. ................................................ · l~.~.~t*a~ ......................................................................................... ,p?su~a?t~_ to ,appJic~?tion dated ..... ;2"r;:','.';r~'"": ....... :"J~t~"" ~1~..., ] 9.~.., and, approved by the Building Inspector. Fee $,-%.-~,00 .......... Building Inspector / Approved ............... [ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. ¥. erm,t Disapproved o/c APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Th~s application must be completely filled in by typewriter or ,n ink and submitted in triplicate to the Buildinf Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing Iocahon of lot and of buddings on premises, relahonsh~p to adloining 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 apphcation c. The work covered by this application may not be commenced before issuance of Budding Permit d. Upon approval of this application, the Budding Inspector wdl ~ssue 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 occup,ed 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 th, Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o 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 t, admit authorized inspectors on premises and in, buildings for necessary inspections. (Signature of apphcant, or name, if a corporation) (Address of applicant) State whether applicant ~s owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or b~dder. ,..: .............................................. enn~.~t~. ......................................................................................................... ~. ...... h~ame of owner of premises ...Jnh~.~&w~nki ............................................................................................................. If applicant is o corporate, signature of duly authorized officer. ........ ~ ~....~.. e.~,.~ ~ orm. ................................................. (Name and title of corporate officer) Builder's License No ..............'~/,..:~.,.,.~..1 ...................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... ~ .~ 1. Location of land on which proposed work will be done. Map No ........................... Lot No .................. Street and Number .... 1.~.gO../)e.e~...l~.~l~...D~.,~...Nat~.~.i~.uuk~....~.,...Y.,...llg~ ......................................... Municipality 2 State existing use and occupancy of premises and intended use and occupancy of proposed construction: a Exisitmg use and occupancy ........ D~e..--.f.g~l~.l~'..ClT~lt.~,l~ .................................................................... b Intended use and occupancy ........ ~t~tm£~3,~r..~t~13~/.~,~ ........................................................................ 3. Nature of work (check which applicable). New Building .................. Addition .................. Alteration ................. Repair .................. Removal .................. Demohtion .................... Other Work ....... ~.etr~ JL:~ ............. (Description) 4 Estimated Cost ..... ~k~,,00 ..................................... Fee ........... ~]L-~ ~O0 ............................................................. (to be pa~d on filing this application) 5. If dwelling, number of dwell,rig umts .........................Number of dwelhng units 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. Dimensions of ex~stmg structures, ff any: Front ........................... Rear ................................ Depth ................... Height ........................ Number of Stories ............................................................................................................ Dimensions of same structure with alterations or additions Front .................................... Rear .................... Depth ................................ Height ........................ Number of Stories .............................. 8. Dimensions of entire new construchon. Front ................................... Rear ............................ Depth ...................... Height .................... Number of Stories ................................................................................................................. 9 S~ze of lot' Front ............. -~00! .............................. Rear ......... :L~O.! ....................... Depth ....... :t.~O.t ..... ; ........ 10. Date of Purchase ........................................................ Name of Former Owner ...................................................... 11. Zone or use distr,ct in which prem=ses are situated ......................................................................................... 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 _.. 179o Deep ~toi~.,D~, ] 4. Nome of Owner of premises ..~'~l~..~W~Ok~ ..................... ~oaress ~'~'t~;"~ ~'none No. Name of Architect ...................................................... Address ................................ Phone No ...................... Name of Contractor ...................................................... Address ................................ Phone No ...................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fron property lines. Give street and block number or description according to deed, and show street names and indicat: whether interior or corner lot. STATE OF NEW YORK, lS.S COUNTY OF .... S~t~'~:!~ ........... ....................................... S~...17~.:~.~ ........................ being duly sworn, deposes and says that he is the applica, (Name of indiwdual signing contrac~ above named. He ,s the .................................................. ~n~e~ ............................................................................................... (Contractor, agent, corporate officer, etc.) of sa~d owner or owners, and ,s duly authorized to perform or have performed the sa~d work and to make and this applicahon; that all statements contained ~n th~s apphcahon are true to the best of h~s knowledge and belief, that' the work will be performed in the manner set fo~h m the apphcation filed therewith Sworn to before me this .... · of ............... M 'q ......... , ' Nora, Public ...................... ~~.].~.~.. Count--' /- (S,gnat~of op~caht) ~A~? PUBLIC. State al