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Home My WebLink About9881-z FOI/~ NO. 2 .TOWN OF SOUTNOI.D BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~SOUTHOLD, N. Y. BUILDING PERMIT (~HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 9881 Z : Date ..... ~...L'i/.....' .......... , 19.Z~f;f' . .... : :...:~.~....'. ..... ,.~ ..... ~. ~,'; ursuant to a I cation dated ............................... , 19~i and approv~ed by the P PP ~- , ~ -.,~,~!-,. , ~ ·. ~ . Building In§pector. TOWN rlF SOUTHOLD OFFICE DF BUILDING INSPE[~TOR TOWN OLERK'S OFFIOE S(]UTHOLD, N. Y. ]]97~ '// .TEL. '76S-266D Z TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ..... ............... (Bu}fdihg' Inspector) APPLICATION FOR BUILDING PERMIT Date ........ ...~..~.!. ~ .......... .~..~....,~. :...,., 19.'~. :%~. .... INSTRUCTIONS o. 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, end giving a detailed description of layout ofproperty 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 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 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 nam~/, if a corporation) ..... ........... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is o corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ...... ~b~.O.~...~.........~..~/..'.c~..~...~,~:..%...... //¢*~-~) Plumber s icense No ......... .~,)...~;".}.~ ......... .k ........ ~ E,ectr,c,on's ,cense ...... Other Trode's License No ............................................... Location af land on which proposed work will be done. Map No.: ........................................ Lot No.~:; ...................... Street and Number .......... ~.¢,,..q~...~..c'.......~.~.~.~....~. ......................................................................... -'~ 7~-,5- Municipality State existing use and occupancy of premises and intended use and occupancy ~f proposed construction: a. Exisiting use and occupancy ~..L~...~.~. ....... .~2..vh..f~.:.,...-~...c:~...'2~...:.~..':~ b. Intended use and occupancy ....]f~. £~.(~...t..~.o.:y~,......-~....~.O..~...~..~-~..~.., ........................ Z .......................... 3. Nature of work (check which applicable): New Building'. ................. Addition .... Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work .................................................... o o o IDescr pt on) 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 ...... ~.....O.. ............ Rear ...... .~.~.....O.. ............... Depth ....'~....~... Height ...,.~...~.r, ...........Number of Stories ....... .~..!.~. ,..~.. ............................................................................................ Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth Height Number of Star es .......................................................... ~ +'~ lID ~-~- "~ 8. Dimensionsto.f./entire new construction: Front ...... L..o~.. ........................ Rear ............................ Depth ..... 1..¢~.. ............. Height ..~..'...~.i .......... Number of Stories ...... ..O.~!..~ ................................................................................................... 9. S~ze of lot: Front ........................................................ Rear .......................................... p .................... :4: ......... 10. Date of Purchase ........................................................ Name of Former Owner .~1..~-.4'..~.R~. ...... ~.J~.~.,Y~,,.'~.i~..?...~..~..'~....~7.,.. 1 I. Zone or use district in which premises are situated ..................................................... .~..~, ......................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........ /~..¢. ........................................ 13. Will lot be regraded .... Will excess fill be removed from premises: ( ) Yes (~C). No ............. ~'"'"";~' -~-g~W .~.~'...~.Z~C~.Address ,,,~...~,~,..~.. , Phone 14. Name of Owner of premises ...... ~.~. ........................... ~ ..... : ........................... __ ~x No. ~......~..~.., ..... N o. '~..~ .~....f~.~...G...~' Name of Architect ..... ................... Address ...(~...9....~.~....0~..?...~. ...... Phone 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· t,~),-~-iO~, ~ROVED AS NOTED BY: DATE:___ FEE: 5. ALL C~ P~P~'$ OF ANY KIND N.Y. STATE ~OD~ CODE & ZONING STATE OF NEW YORK, fl ,~.c S ' [ CO LJ,N'['~O F · .....?:~ ......... 1.....~....4 r ........... ..~...~...~..!...~....~...~ .................................... being duly sworn, d~pases Ond/ says thO'1 he is the applicam (Name of individual signing contracf) above named. ..o....&..M.., He is the .......km~...~...:~.~.....~ (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 this application; that all statements contained in this application are true to the'best of his knowledge and belief; and thor the work will be performed in the manner set forth in the 9pplication filed therewith. Sworn to before me this .... ................... , Notary Public, .....~./.. ............. County ................ /~....~ ....... ~:.,..~, ........................... U ~ (Signature or applicant)