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Home My WebLink About10334-z FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) N.o 10334 Z Date ........................................................ , 19 ........ Permission is hereby granted to: ..O..L!.!L~.r~.......~. ....... ~,!,~.b!.~ ........ ..c..~.~.~ L L_ '" "" ................................... ' ............. ¥'i'"q:~'~ .... ~o '-~u,~ ~ .F~ E ~dc~ . , ~U7 ~/-IOGU&- pursuant to application dated dULY 5/ 19..7...~. ond approved by the Building Inspector. .......... Examined ............. Approved .......... ~ Disapproved o/c FO~M ~qO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 7 ................................................................................... ........ (Buildin~ Insp~tor) Application Nd. ............. ~ ................ APPLICATION FOR BUILDING PERMIT Date ............... L) ~ ....................... , 19...~...~. .... INSTRUCTIONS o. 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, relationship to adjoining premises or public streets o~ areas, and giving a detailed description of layout ofproperty must be drown on the diagram which is port of this application. c. The work covered by this application may not be commenced befor~ issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue o 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 name, [fa corporation) 2. ..& ................................ .~ ......... ;..q.u~.o.,'~....r.:~.J (Address of applicant) / ~J-~.)'~ / State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................................................. ..0..~.~.~..F.. ......................................................................................................... Name of owner of premises .................................. ~ ................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......... ..O.....~.....~....~..~.. ..................... 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. ~ ....................... Sr nd r L~ %2' %~/,U~'/ L .~..,--~-~1- .o t eat a Numbe ............................................................... , ............ C~.....C ................... .C.L~...~..~.~.,....,.~.....C..;..,Z~.. 7 Munici~ality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a Exisiting use and occupancy ................ ~, ......... ..~....~.,. :.! ....... ~.~.., .(',.[.J..l ................................................ b. Intended use and occupancy ................. ~...~,.~[..~,.fL ......... ~......~ ....... ~..~/Z.O....~.. ..................................... 3. Nature of work (check whicl~ applicable): New Building .................. Addition .................. Alteration ............... Repair .................. Removal~ .................. Demolition .................... Other Work ................................................... (Description) 4. Estimated Cost ........... ~ ....................................... Fee ......................................................................................... ~ t(~t~be paid on filing this application) 5. If dwelling, number of dwell;lng units ............................ Number of dwelling un,ts on each floor ........................... If garage, number af cars '"'i ....................................................................................................................................... 6. If business, commercial or jmixed occupancy, specify nature and extent of each type of use ........................... 7. Dimensions of existing structures, Jf 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 co~struchon: Front .................................... Rear ............................ Depth ........................ Height .................... Numbe~' of Stories ..................................................................................................................... 9. Size [of lot: Front ................ r ....................................... Rear .......................................... Depth 10. Date of Purchase ................ ; ....................................... Name of Former Owner ........................................................ 11. Zone or use district in whichJprem sas are situated ......................................................... ~).~.~ ............................ 12. Does proposed construction vliolate any zoning law, ordinance or regula~%,.~ ................................................... 13. Will lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes ( ) No .... i ................................................ Address ................................ Phone No ....................... 14. Name of Owner of premises r Name of Architect ..............: ............................................... Address ................................ .Phone No ....................... Name of Contractor ............ ' ................................................ Address ................................ Phone No ....................... : PLOT DIAGRAM Locate clearly and distinctly a,II buildings, whether existing or proposed, and indicate all set-back dimensions from property nas Gwe street and blbck num. ber or description according to deed, and show street names and indicate whether interior oF corner lot. STATE O~ NEW YO~I< . / ~ t S S ~'= [ ~ COUNTY :OF ' ~~ ' ~ ~ ~ ............... ' ' L ¥ oses .......................... ................................... (Nam~ of ihdividual signing contracf) ' 'F'~/ ~ 'F above named. and says that he is the applicom He is the .............................................................................................. ~ .................................................................................. ' (Contractor, agent, corporate officer, etc.) of s(~id owner or owners, and is d~ly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application ore true to the'best of his knowledge and belief; and tha~ the wbrk will be performed in (he manner set forth in the application filed therewith. .S..w..~ i.~..t..o..b~.o~. :e~,~ayt ho;S ............... ~/f.~......, , 9.... Nota P b,,c,. ..... ...... ........ ....................... ~ JUDITH T. TERRY ~ ~' Notary Public, State of,New Yor~ No. ~2-0~4963 Suffolk : Commission ,Expires March 30~ lg~,/