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Home My WebLink About9822-z FO~M NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICF. SOUTHOLD, hi. Y. et premises at pursuant to apF '7' ........ and approved by the Building Inspector. ~' ............ ~ll~lBg Inspector ....................... FOR,N~ NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ,, ~ SOUTHOLD, N. Y. ~pproved ~Zi"~.'! ............ , 19'~2 Permit No ~.~ INSTRUCTIONS o. 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 or areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is port 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 inspecti~ 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 Deportment 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. ............................/ State whether applicant is owner, les~e, agent, architect, engineer, general c~tractor, electrician, plumber or builder. ....................................... ................................................................................................................................. ............................................................... 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 ............................................. Location of land on which proposed wor~k will be do~,L,,Map No.: ........ ,L.~/.,,.A ..................... Lot No..~../....~2.. ............. Street and Number ............... ./.~.~..~.~......./.~..~.C~?.~'.~.....~' ~.~..,......~..~....~..~.~...Z~.. ........................ / Municipality State existing use and occupancy of prerr)ises and intended use and occupancy of proposed construction: a. Ex,s,t,n use occupancy b. Intended use and occupancy .................. --'....~../~,~..f....~.~..;..~.. ............. ~.:~.' .........~... ........................................................... .. 3. Nature of work (check which apl: New Building' ... ~ Addit ................. Alteration ................ Repair .................. ,~,Pcj~n o va I ..................Demolitior ..................... 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 o¢ cars ....................................... ~ .................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of u~e ............................ 7. Dimensions of existing smJctures, 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 ..g..( ............ Number of Stories ..... ~-~ ................................ 7~=':~"-;;") ........ Size of lot: Front ................ ~-- --~"¢/ ......................... Rear ..... ~¢~ ......... ,~ ........D ptb ..... ;~..::s~ ............... 0 w n e r ~.~¢~...~..~.~ Z~ 10. Date of Purchase ........... ~ZZ..~.~ ..................... Name of Former 11. Zone or use district in which premises are situated ............................................................................ ~ ....................... 12, Does proposed construcfio~ v~olafe any zoning law, ord' g : ~.¢ .................................. 13. Will lot be regraded ...... X/¢~ ........... Will excess fill be removed from premises: (~ Yes ( ) No 14. Name of Owner of premises ~4..~2..~*~¢ ..... Address .~:.~ Phone No. Nome of Architect ............................................................. Address ................................Phone No ....................... ~ome of Contractor ............................................................ Address ................................Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly ~11 buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according ]¢ deed, and show street names and indicate whether interior or corner lot. ~ ~_ ~ STATE OF NEW YORK, lc c COU N 1Z~6~OF ................................ ..~..~../f~..~._.~ ........... be ag duly sworn, deposes and says that he is the appiicam (Name of individual signing contracf) above named. He is the ............................................................................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or h~ve 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 that the work will be performed in the manner set fo~h in the appi~tion filed therewith. Sworn to~fore me this ~.~.~~ ~ / / ~~.,~/ ......................... ..... G~,tTRIJDE ~LIZA~ETI,f PO~T[~ ~/~ / ' (Signature of applicant) Notary Public, Ctnte of NeW Y~l'k ~ Or,ah(md )n Nassau County