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Home My WebLink About10329-z FOI~M NO. 2 TOWN OF SOU?HOLD 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) No. 10329 Z Permission is hereby granted to: ....... z:/..2~rz.~...:../~..~:~z....~:.. ........ ~..Z..~..z~.cz~...z...~..: ................. ................~.c/. ~.,'~/~C~...~ ..-...~..:~, ..... ~o ........ ~22./..~..~..Zr.'c.~.cT.. ...... ,~.~..~,r~..../~..C.c.~.~.~ ........ ~x~r,~.~ ......... ........... ~.~'~.~.....: ............................ ~ ........................................................ ? ............................. at premises located ~~.~.....~/~...~..~.[--~.~..~.....~,......~....~..'/..~.~.(~.~ Building Inspector. Fee $.../~. ............. FORM NO. 1 TOWN OF sOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined ~jO~c./~ c~r) 19 Approved ~ Disapproved a/c ...... -.-. ?~....: ............... ~.: ..... ~.. (Building Inspector) APPLICATION FOR BUILDING PERMIT . / z .... 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, relahonship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. 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 Ordmance 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 ~I0~c~on.s/ .... .... ....... (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nmne of owner of premises..~..~. ~ :~.~....~.~ · .~ .~.A?Z~'*..~.'~. .~.' ................................... (as on the tax roll or latest deed) If applicant ~s a corporation, s~gnature of duly authorized officer. (Name and title of corporate officer) Builder's License No ...... x.~?'.~ ./-../-. ' .~/ .......... Plmnber's ~icense No ......................... Location of land on which proposed work will be done ................................................ ........ . . ........... . . . ............ .,. ............ House Number Street Hamlet County Tax Map No. 1000 Section ....,/-~17. ......... Block .... ~ .......... Lot. ~..-.~.' .............. Subdivision ................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....~.W'..~ .~.,~. ?./~...~..~.~.~....~/.¢z../y,./.~..1/. i ./p~?..c,?.~ ....................... b. Intended use and occupancy 3. Nature of work (check which applicable): New Building .. CP~...... Addition .......... Alteration .......... Repair .............. Rempval .............. Demolition .............. Other Work ............... 4. Estimated Cost . . . ['. ....... : .......................... Fee .................................... I (to be paid on filing this application) 5. If dwelling, number of dwelhng, units ............... Number o f dwelling units on each floor ................ If garage, number of cars .... I ..................... , .............................................. 6. If business, commercial or mixed occupancy, specify nature hnd'extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure vCith alterations or additions: Front ................. Rear .................. .Depth ................... i. · · Height ........... ,-~, ........ Nu.n)~ber,of,~.tories ........ z~: ' ~'~ ........ 8. D~rnenslons of e~ltlre,n.qw constlructmn. Front .... ~t~..~f~. .... Rear . .~.. ~ ......... Depth .~. ~ .......... Height ...... ~.. ~.~ . . . Number of.~ones .... / ........... ~...' .................. ,~ ................. 9. Size of lot: Front ........ ~/..~... fi. ...... Rear.../('.~...~ ............. Depth .. ,~'. ................. 10. Date of Purchase .......... i ................... Name of Former Owner ............................. ' 1 1.Zone Dr use district in which p~emises are situated ....................................... . ............... 12. Does proposed construct~on wqlate any zomng law, ord~nanceorregulatlon: ..~'d.: ......................... 13. Will lot be regraded .. . .,, ........... Will excess fill be removed from premises:_ Y~es No 14. Name of Owner of pr;~i~s' ~t.~i~,i ~.~.~.~ .~'*~..... Address ~..~ ~,~it~.~r~,.'~..~,. Phone No.~.~. '~. ?./'.~...~.".. Namd of Architect ......... I .................. Address ./-..~'.'~.~..'~. '.~.~. (.,~.: .F'.. Phone No ................ Name.' of Contractor ........ , .................. Address ................... Phone No ................ Locate' clearly and distinctly all property lines. Give street and blocl integer or ~corner lot. PLOT DIAGRAM buildings, whether existing or proposed, an& indicate all set-back dimensions from number or description according to deed, and show street names and indicate whether ..... ~ ~.~.~.~. ~-~. ~'/.' i.. ~ ........... ' ........ being duly ~worn, deposes and says that he is the applicant (Name of individual signing contract) above named. ~ Hei th o O,Y~(~.~.. , I (Contractor, agent, corporate officer, etc.) of said owner or owners, and is doly 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 that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ..............ti ~ ~a' ......... day (~f ..................... , 19 2,,~ .............. .................. ' i ~i,~i~;~;;:t,,, :i~, '~'""' (Signature of applic~t)