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Home My WebLink About9177-z FOI~FI NO. 2 TOWN OF SOUTHOLD ilUILDING DEPARTME~IT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~REMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9177 Z Permission is hereby granted to: ..... k~zL,e......f,.'.!.~ ~:! .,~...~:L: .................................. ................. ~..~;L?~,~...?.?..r,. ....... .~.t.:U~.~.~. ......... at premises located at ..~/.?....~.~2~.~.~...~ ........................................................................................ Me ~ t ~ ~ak pursuant to application dated ...................... ~..~. ........'1..1 .......... , 19....~.~.., and approved by the Building Inspector. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined //~i)/~// // 19~]..~ prav,d ...... ../../.. .......... , ,,:2.2 P, rm, ..... ...... Application No. ~/~/) ~ (Building Inspector)/ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter o~. in ink and submitted in triplicate to the Building 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 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 o 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 port 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 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 a~terations, or for removal or demolition, as herein described. The applicant agrees to comply with oil applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and i~ buildings for necessary in~ctlons. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrJcion~ plumber or builder. Name of owner of pram ses ................ . ................................................................................................................................ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... : 7/~ Location of land on which proposed work will be done. Map No.: ......... , ........ ..:. ....... .'~ ........ Lot No ......... t ............... Street and Number ....................... ../x:..:...~:,../..C.~..~.. ....... ~../~..~.~, ...... .,~,~..~/~.~/. 'Z..~..~./~. ....... ./.'.~....,~..,. ...................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy /.-~,.0.,.~..~ .......................................................................................... b. Intended useandoccupancy ....... .~...~....~..~..~...~.~.......!,.1~,~., ...... ..~,,,..~,..~..; .~.,.....9.~...[ ...~..,.~.~.,.~,~ .............................. 3. Nature of work (check which applicable): New Building'. ................. Addition ....... ~'~'~i' Alter,a, tion ................ Repair .................. Removal .................. Demolitior ..................... Other Work ....~,.~./..../~...~{~. .................... (Description) 4. Estimated Cost ............................... Z ........................ Fee .~...~.~: ...................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, number of cars ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if 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 construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ..................................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Dote of Purchase ........................................................ Name of Former Owner ........................................................ 1 1. Zone or use district in which premises are situated ......... ./D. .......... ~...~....~¢'. ..................................................................... 12. Does proposed construction violate any zoning Iow, ordinance or regulation: ........................................................ 13. Will lot be regroded . ........~.....~.. ........... Will excess fill be removed from premises: ( ) Yes ( ) No 14. Nome of Owner of premises~.?./.~....C...~...~../~.d......~..'..Afl...(.~....~.: ..... Address '"'"L2' ...................... 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 from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORIC ' COUNTY OF ...... S..u..~ ~.o...Z..k.'. ......... ................................... ..~..~..~...~.~.,..~..*.~.~1;[,,], .......................... being duly sworn, deposes and says that he is the opplicom (Name of individual signing contract) above named. Fie is the ..................................................... ..O..~..QCL~.. ............................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file th s opp cat on; that ali statements contained i~ this opplicetion ore true to the best of his knowledge and belief; and tho~ the work will be performed in the manner set fo~h in the oppffc'otiofi filed therewith. Sworn to before me this ......... ..... .................... ............ , : Nota~ Public,. ........................... ~.~.[ ~.~ .......Coun~ ...~, ....... C~..:.:. ....... &..f~.~Z~.....;Z .................................... (Signature o~ applicant) '¢ ~btZABErH ANN NEV LL~ ~e n Ex rres Ma c 3 , 19~