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Home My WebLink About9275-z I~ORM NO. 2 TOWN O~ SOUT~OLD BUILDING DEPARTMENT TOWN GLERK'S OFFIGE SOUTH'OLD, N. Y. BUILDING PERMIT ~'I'HIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9275 Z Permission is hereby granted to: ......... JlatJ, i~k ................................................ ~' at premises located at .~.~..~.. ]P~tei,!~....~...~... applicatiofl da~ ~ ..... . ..........]9.~. :,, and approved' by the Building Inspector / FO~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E×am,ned ...... Approved i' ........... 197. ~. Permit No. C~,_ ......................... ...... ............. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date ....~.~.~/~...,.~,,., .......... , Application No ...... ..?...~....:.f....~...... a This application must be completely filled tn by typewriter or ,n ink and submitted in triplicate to the Buildin laspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan shawmg location of lot and of buddings on premises, relationship to adioinmg premises ar public streets c areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this applicatio, c. The work covered by this apphcation may not be commenced before ~ssuance of Build,rig Permit. d. Upon approval of this application, the Building Inspector wdl ~ssue a Build,ng Permit to the apphcant. Such permi shall be kept on the premises available for inspection throughout the work. e No building shall be occupied or used m whole or in part for any purpose whatever until a Certificate of Occupant shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issue of a Building Permit pursuant to th Budding Zone Ordinance of the Town of Southold, Suffolk County, New ]~{.4S'rk, end other ap/~,licable Lgws, Ordinances c Regulations, for the construction of buildmgs, additions or alterations, or/for relGovol or d~r~blition, .es herein describec The apphcant agrees to comply with all applicable laws, ordinances, bu~'ng r_~de, housir~ ,~ode, ag(~ 'regulations, and t adm,t authorized ,nspectors on premises and in buildings for necessa~ insp/e~tio.~v. ............. ............ (Signature Of appli~cant, br~name, if a corpor~ion) (Address of applicant) State whether applicant J~'~essee, agent, architect, engmeer, general contractor, electrician, plumber or builde, lxl~me of owner of premises ......... d. ............................................ If apphc~nt ~s a corporate, signature of duly authorized off~cer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ..................~..~. ...................... Location of land an which proposed work will be done. Map 1'~ .................................... Lot No ....................... Street and Number .......... ..' ---.~ ~--"-"-- - -'"4~""¢~/'~"'~"""/~"~t~'~' ..... ~ - ~ --~ ~.. ~L~"~,--e~ --.....t....~'.~ .............. ' Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a Ex,siting use and occupancy ~ ~~~..... b Intended use and occupancy .............................................................. 3 Nature of work (check which applicable). New BLuldmg .......... Addition~.~/ /2' ~']",Y~ ...... AIt. eration ....... Repa,r ............. .~moval~.,~,~/~tt,~ Ox .............. Demoht,or ..... -~-...~..-~ ............................(..D...e~,~t.i.~n).. .~. (to be paid on filing thru applicahon) 5 If dwelling, number of dwelhng un,ts ................... Number of dwelhng umts on each floor .................... If garage, number of cars ........................................... :...~ ....... .;: ........................................................... 6. If business, commercial or m~xed occupancy, specify nature 6nd .e~l~:tent of each type of use ........................ 7 D~mens~ons of ex~stmg structures, ff any: Front .................... Rear ................................ Depth ................ Height ........................ Number of Stones ............................................................................................ D~mens~ons of same structure with alterahons or addmons Front ................................... Rear ................... Depth ............................. Height ....................... Number of Stones ............................ 8 D~mens~ons of enhre new construchon Front ............................... Rear ........................... Depth ................ He~§ht .................Number .of Stones ................................. ~t~ .................................................... 9. S,ze of lot Front. "~"~r ~ '-,~:~" 0...~.-..,,. ~- ..................... Rear ....I~-~/.q. .................Depth ......~..~..~. ........... 10. Date of Purchase .... ...'~...~.~.....-Z.. ....... .~..(~.. ............ Name of Former Owner ...................................................... I I Zone or use d~stnct in which premises are situated ................................................................................. 12 Do_es proposed construchon violate any zoning law, ordinance or re~quJahon ................................................. 13- Will lot be regraded ..... .~ .......... Wdl excess fill be removed from premise_s: ( ) ~ (~No 14 F~ame of Owner of prem,sJ ..~/~.~ ~ ...~.~I.~:4.. Address~ .... ~ /t~...~.~ ..... Phone Nome of Arch,tact .............. ~,, ................. Address .................. ,~ .......... Phone No...~..~..~.....~....~. Nome of Contractor ..... ~ ~ .~..-~. .... Addres ....... Phone No PLOT DIAGRAM Locate clearly and d~shnctty oil buddings, whether ex=sting or proposed, ond red,cate oil set-bock d~mens~ons fror~ property hnes Gwe street end block number or descnphon according to deed, and show street names and ind=cat, whether interior or corner lot z'~ STATE OF NDvV Y(;~K,/.,/~ ~,~' ~c c COUNTY OF ..:~~C.f~ ....................................................................................... bmng duly sworn, deposes and soys that he Is the apphcat (Name of individual signing 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~ th~s apphcahon; that all statements contained ~n th~s apphcahon are true that the work wdl be performed m the manner set foffh ~n the apphcation filed therewith. Sworn to befo~ me this ........ ~..~.~ ~y ~f..:~..~~..~., 19. JUDAH Y T~RRY (Signature of opphcont) Camm's3 on Exp,res triarch 30,