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Home My WebLink About9121-z FOI~I NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SGUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 9121 Z Permission is hereby granted to: ....P..e. ~ .e..r....~ .o.g..o.?..t..~. .............................................. ...................... ~,~ ....................................... at premises located at ....~./.~.....N..gr.~..~.ml..~r~..~8~c~.i~w..~..~oo. le...(~.e~ ....................... ............................................. l~,~t~o~....~x ~ .................................................. i .............................. pursuant to application dated ............................~.2..~.......~.~. ............ , 19~/.~....., and approved by the Building Inspector. Pee $.~5..:..qP. ........... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Yo E×om,ned ..... ...... ~proved .................... '.3 ....... 0..~.., 19....~/Permit No ..... .~/...~...~....~.. Disepproved ~ __/ ~._~ ~~~':~ ....... :~ ................ ~ ............... ~ ................. ~ ................ ~i~ I~or) APPLIGATIO~ FOR BUILDING PERMI~ INSTRUCTIONS a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Building Inspector, with 3 sate of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of Jot and of buildings on premises, relationship to adjoining premises or public streets or areas; and giving a detailed description of layout of property 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 a 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 Deportment 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 of applicant, or name, if a corporation) ........ ..................... State whether,apl~licantif~.~,w~r~er,,J~ssee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........................................................ .................................................... Name of owner of premises ............................................................. ./.. ................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ...... ..~.2~::~.~J.q:~...,,..'~.~,..,..,..--~- Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... Street and Number .................................................................................................................................................... Municipality 2. State existing use and occupancy of prerrAisgs and intended use and occupancy of proposed construction: IV b. Intended use and occupancy ...................................................... '"~---~.......-:~'.:.~:;z..,.?... ..................................... 3. Nature,of work (check which appiicoble): New Building,. ................. Addition ......... -,.z::.... Alteration ................ Repair Removal .................. Demoli~:ion .................... at er Work ...... t ....................... r ..................... ~ /~_ ~ (Description) 4. Estimated Cost ............................... '. ............................ Fee .......................................................................................... (to be peid on filing this ~pplic~tion) 5. If dwelHng, number of dwelling unffs ..... ~ ........ Number of dweUing units on e~ch floor ............................ ff get, ge, number of cars ............................................................................................................................................. 6. If business, commercial or mixed occuponcy, specify noture ~nd extent of eech type of use ............................ 7. Dimensions of existing structures, if ~ny: Front ............................ Reor ................................ Dept~ .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of seine structure with ~lter~tions or edditions: Front .................................... ~e~r ............................ ~epth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ................... , ................ Rear ............................ Depth ........................ Height .................... Number of Stories ~. .................................................................................................................... 11. Zone ar use district in which premises are situated ..................................................................................................... ]2. Does proposed construction violate any zoning law, ordinance or regulation: ...~ ............................................. 13. ~ill lot be regraded . ........................... Will excess fill ~e removed from premises: ( ) Yes ( ) No ~ome o{ Architect Addross ................................ Phon* ~o ....................... Mome of Contr*ctor ....S.Z.[; ......~{...} ................................... Address ................................ Phon~ ~o ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-~ck dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whefl~er interior or corner Io~ STATE OF NEW Y~RK, [ S S COUNTY OF .'~,,,_,c;~/'~ ....... f ' ......... , ......... :..~......~..~'~r~.~.cr. ~'..~:;..~ ~[.~.,?:~--~..-- .~, ................. being (Name of individua~ signin~j-contract) above named. .~R', ~q~ [-4 duly sworn, deposes and says that he is the applicant Fie is the ................................................................................................................................................................... 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 k~c.~ge and belief; and that the work wi!,l be performed in the manner set forth in the application filed therewith. [' '~ Sworn~...~..~.t~efore me thiSof .~:.~J~'~. ~ 19,.~. ~ / ....... ........... , , ~ ~v+ ~..~.~ ..... ,o or, ................ Co.. ........................................ ............................................. ~,~-,~ (Signat~e of applicant)