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Home My WebLink About9908-z FOEM NO. 2 TOWN OF sOUTHOLD TOWN CLERK's OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE pREMIsES UNTIL FULL' COMPLETION OF THE WORK AUTHORIZED) 9908 Z Permission is hereby granted to: ................... ~.~.L~.~..A~p.~ .................................. 1000..18-6-12 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE Examined ..... '~U,i~O,S"C ....... '2'2 ......... 19'""~8 Approved ......J~Q'~tt~'t ....... ~2 ........ , 19....r~8 Permit No .......... ~(~SE ............... Disapproved a/c ............................................................................................ Application No ..... .9~gt]~, ............. i~,' (Building Inspector) APPLICATION FOR BUILDING PERMIT Date .................... ..~././..~.. ............... , INSTRUCTIONS a. This application must be completely filled in by typewriter aC 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 areas, and giving a detailed description of layout ofproperty m'ust be drawn on the diagram which Js 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 o 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 ir) buildings for necessary inspections. ................................ .............................. ' ........ If applicant is a corporate, signature of duly authorize f (Nome and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1. Location of land on which propo~o;k, w~ill~be~:~p N~/ ................... ~ .......... ,Lot No ......................... Street and Number .................~.~.~.,~¢.....4.~..; ........ .~- ...... Municipality , 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ................................................................................................................................ b. Intended use and occupancy ................................................................................................................................ 3. Nature of work (check which applicable): New Building~· ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ..................................................... (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 oars ..: .................................................................................................. ~ .......................... . .............. 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 olteratians or additions: Front ....................................Rear ............................ Depth ................................ Height .......... ~ ....... : ........ '.Number of Stories ................................ 8. Dimensions of entire new construction: Front .................... · ............... Rear ........................ .... Depth ........................ Height .....~/A?. ........ Number of Stories ..................................................................................................................... 9. Size of lot: Front ....................................................... . Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 1 ], Zone or use district in which premises ore 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 ( ) No 14. Name of Owned.of premises ........... ...i ..................................... Address ......... ; ................... ,., Pho~e No...: ................... Nam, e of Architect ........... , ........ i ........................................... Address ................................ Phone NO ....................... ~ ct Add 'Phdn N ' Nam of Contra or ........... :: ......... ...................................... ress ................................ e o ....................... Locate clearly and distinctly all buildings, whether existing or propesed; and ,indicate all set-back dimensions from property lines. Give:stree}~and block number or description according to deed, and show street :na~es ~and indicate whether _~ STATE OF NEW%O~K;.->. ~ ~ ~ c ¢ ................................................................................................. being duly sworn, deposes and says that ~e is the opplicam above nomedh/~ ~/~ /72. He is the ................................................................................................................................................................................. this application; that aH statements contained in this appIicaHon are true to the'best of his knowledge and belief; and tha~ the work will be performed in the manner set fo~h in the application flied therewith. SWorn to before me this. ........................ day of ............................................ , 19 ........, /~ / / .... Notary~l~) .................. ~.~/.~./~.~ .~... Coun~ ~ ....... ..~¥.~..;~....¢~t~...s..,,....~..~..~...,..~.~....~v