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Home My WebLink About9946-z FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTItOLD, N~. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK ^UTHORIZED) N? 9946 Z Permission is hereby gronted to: .~-~.~.o.~.~ ........... ~.~.~ ..................... at premises located at . . .... ................................................................................ "" .................... ....~2. ......................................................... u~guont too c~ton doted Buii'ding.. . Inspector. TOWN OF SOU*rHOLD BUILDING DEPARTMENT TOWN CL~RK'S SOUTHOLD, N. Y, ................. (Building inspector) APPLICATION FOR BUILDING PERMIT ~. Date ....~,l~.l~a.t.....~8 ...................... 19...~.8....~>~ 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 plons, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to ad oining premises or public streets areas, and giving a detailed description of layout ofproperty must be drawn on the diagram wh ch s part of this application c. The work covered by thru application may not be commenced before ssuance of Build ng 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 Occupancv~ 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 theq),, 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.r 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. ~lgnaTure at app icanT, or name, it a corporation) (Address at applicant) x~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.~l .................................. oen.t, Be.t, z ........................................................................................................................................ Name of owner of premises ~0~ ~.~. ~O~ .......................... 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. Mop No.: ........................................ Lot No ......................... Street and Number .]..~.c3~...~.,l~..~.~.b~..T,m~..}.~.f,f,z.~',~...H...~.. ..................................................................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ...~...~"~:L.1,~....~!.~ZL~,~'~ ................................................................................ b. Intended use and occupancy ....... ~.~,~..~.~..c!~t~.]..:l.~,~, .......................................................................... 3. Nature of work (check which applicable): New Building~· ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ...... ~..e.~d. ~D. ............................. (Description) 4. Estimated Cost ...~.3~.~.~k¢~ .................................. 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 .. ~..~..: .......... I-Jeight .................... Number of Stories ..................................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ ~0. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. 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 ( ) No 14. Name of Owner of premises "~-'1'~G'6'~"~'~"~'~ ................ Address ....~t~l~qt ................... Phone No. ~,~J..'.~[.~k~... 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 YORI(,, ~ c c COUNTY OF .... ~tl.~.Z?. ~k ........... fo.,, .............. ,~.~...Pe,~:J:,O.e~I~.~...; .............................. :',' ................. being duly sworn, deposes and says that he is the applicam (Name or inaiviaua signing contract) above named. He is the ....... eo. rl~'.~.~..o, lff. .............. . ...................... (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 app cat on; that oil statements contained in this application,are true to the best of his knowledge and belief; anc th. ar the work w be performed in the manner set forth in the al:mlication filed therewith. . Sworn to he, fore me this , ~r ~.~ - ~.~ ,~/7' / ..,. .-. ~ ./ , .., ........ .... ....... , .7 ," Notar Pub c, .~.....:~.,.~.;;.i~:,;:d....~;i~!~ ....... C'6unty ......... .~,,~ ........................ ~, ......................................................... , n " (Signature of applicant)