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HomeMy WebLinkAbout10070-z FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N,. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 10070 Z Dote .: ' ~..Z..5.., Building Inspector. Pee ,..Z.~.... .......... Examined .... ,.~ ....... ,..- ................. , 19 l~ NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No../..~.'..(~..?...~.. ............ Disapproved a/c ................................................................. ~7"[ ................... ( B u'~'ding Inspector) APPLICATION FOR BUILDING PERMIT oo. ...... ......... INSTRUCTIONS a. This application must be completely filled in by typewriter or' 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 o~ 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 )ssuance 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 purl~ose whatever until a Certificate of Occupancy shall have been granted by the Building ~nspector. 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 atterations, 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. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....................... ....................................................................................................................................... Name of owner of premises ...... .,~.-~,,--~,.:.~-../,.~.)......(-~-,'-~...~.',*'.S ............................................................................................. 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 ............................................... Location of land on which proposed work will be done. Map No.: ........................................ Lot No ......................... Street and Number ....................................................... · .~.../. ........................... : ....................................................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a, Exisiting use and occupancy ....... C.~./~. '""'~J~ ......... 7 ................................... 3. Nature of work (check which applicable): New Building,. ................. Addition .................. Alteration ................ ~_7/(~0 f (Description) 4. Estimated Cost ............................................................ 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 .......................................... 7"~ r2/Depth~' ............................... 11. Zone or use district in which premises are situated ..................................................................................................... ]2. Does proposed construction violate any zoning Iow, ordinance or regulation: ........................................................ 13. Will lot be regraded . ........................... .Will excess fill be removed from premises: ( ) Yes ( ) No Name of Architect .............................................................. 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 black number- or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW COUNTY O~, ~.., ..~.~ ~;~,~ .............. ~......~~ .................................. being duly sworn, deposes and says that he is the app[icam (Name of indiW~ual ~gning contrac~ above named. He is the ....................... ~,~,.~~ .............................................................................................................. ~ontracto~gent, corporate officer, etc.) of s~id owner or owners, and is duly aut~o perform or have performed the said work and to make and file this application; that aU statements con~aJ~ed Jn this appl~cction are true to the best of his knowledge and belief; and tha~ the work wi[I be performed in the manner set fo~h in the application filed therewith. Sworn to before me this · ...~1.~..~... day of ..... .~~......, 197.~ ~)~ ~ ~ -- ,. % YOUNG & YOUNG ANGER ~,VENU[~', RIVLRI{EAD, NEW YORK i/',UGLES DOCK, HOWARL~ W, yOUNt~ INC.