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Home My WebLink About10371-z FOEM NO. 2 . TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) ........ .~.~.~.z. ..:.~...~. .................... .. .~,,.,_,.~..~.......~'~z]_~......; ................................................. :~ ................ /.. ................ ........ to application dated .~....~....~.. .......................... , ]9..~...~, and approved by the pursuant Building Inspector. (/ Fee $../~.Z.~.... ' Building Inspector FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y, 11971 TEL.: 765-1803 Examined '..~..~ .... ~. .... , 19~..? -, Application No..~..~..7./. ....... Approved .~..~..~. ..... , 19~? ?. Permit No../~..~. 7/ ~ .4 Disapproved a/c : . . . . . . . .~-.'-.~...~ ............ ~ ....... APPLICATION FOR BUILDING PERMIT Date .... 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, relationship to adjoining premises or public streets or areas, and g~mng 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 b.e 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 pu. rsuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, Ne~v York, and o[hdr 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, if a corporhtion) o,. (mailing address of applica/nt) State whether applicant is bwner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. .... .................................................................. .'.' ........ Name of owner orpremlses . ~.~..~d'.7'].4'~...../~.,~.~.~. ........................................... (as on the tax roll or latest deed If applicant is a corporation, signature of duly authorized officer· (Name and title of corporate officer) Builder's License No../.~./. 2.-': ........... Plumber's License No ....................... Electrician's License No ....................... Other Trade's License No ...................... House Number Street Hamlet County Tax Map No. 1000 Section . ..~¢Y~- ........ Block ..... ~g ......... Lot.. ~.~.~ ........... Subdivision ..................................... Filed Map No. ~...: ....... L~t ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: Existing use and b. Intended use and occupancy ~z.~'.. ~/.. ~ ~(~. ~V~(Z Z ~ 1~ 10. 11. 12. 13. 14. . ,./.. Nature of work (check which applicable): New Building .......... Addition .......... Alteration Repair .............. Remoyal .............. Demolition .... , .......... Other Work ............... Estimated Cost .................................. Fee ................................. (to be paid on filing this application) If dwelling, number of dwelling 4nits ............... Number of dwelling units on each floor ................ If garage, number of cars ........................................................................ If business, commercial or mixed' occupancy, specify nature and extent of each type of use ............ . Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth .................... i' · Height ...................... Number of Stories ...Z'. ..... ... Dimensions of entire new construction: Front.../or~. .Q. ...... Rear ....~.//. ........ Depth .../~. Height .. ~Z.~../~. ...... Number of Stories .................... ': ................................... Size of lot: Front ..... ~5.-~;~... i ......... ~ ' /CD c~ Rear... ,5 D ............... Depth.. ......... ;; .......... Date of Purchase ....... Name of Former Owner .~/~5.,~~. ~'.,~.~. /'it. Zone or use district in which premises are situated.. ,/~Z~'~..~.~,g~. ~d .... ¢) ........................... Does proposed construction violate any zoning law, ordinance or regulation: .. A/.lt ~ .................... Will lot be regraded .. ~L.0...... ....... , ........... Will excess ,f,!ll be removed from premises: Yes ,_' Name of Owner of premises/J, td/)/.~..f'./~',~..-C~ ..... Address ~l~/~0d~ ....... Phone No. ~.'7..~t~.... Name of Architect .......... ~ ..... Address ................... Phone No. Name of Contractor . .~.~r~0.. i/2~.ff. ,t!~.~'. . Address. ~'a#~j/0d~ ........ Phone No. ~.~¢-.' PLOT DIAGRAIvl Locate clearly and distinctly all Ibuildings, 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 ~OV TH STATE OF NEW~R~. . ..........~~ ~r~...[~~.. beingduly sworn, deposesand saysthathe is the applicant ' , (Name of ~ndividual signing contr~t) above'named, ~ He 4s the .... '~ ............................. of s~d owner or owners, ~d is dully authorized to perform or have perfomed the said work and to m~e and file this application ;' that all statements contained h this application are true to the best of his knowledge and belief; and that the wd}k will be perfomed in the manner set forth in the application filed therewith. Sworn to before,m~ this ~~R~ P~LI~ ~tate ,of Ne~ Yo~ ' ~/ ~ - (Signature of applicant)