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Home My WebLink About10372-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) pursuant to application dated ..................... , 19. and approved by the Building Inspector. ? B~ldin~g Inspector FO~[ NO. 1 TOWN OF .SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ........ ......... . ............. ~proved ~ ~[ 19~7 Permit No /~'7~ ~sapproved a~ ................................................................ ~ ..................... .............................. ;~r~~~ ................... APPLICATION FOR BUILDING PERMIT 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 giving o detailed desqription of layout ofproperty must be drown on the diagram which is part 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 o Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No buildmg 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 th.~ 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. [[').t~n Fork Fence Co. (Signature of applicant, or name, if a corporation) iLoute 27A, Mattituck N.Y. 11952 (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. co~tractor Name of owner of premises Richard L. Gibbs If apphcant ~s a corporate, signature of duly authorized officer. ................. ¢.'.,.~.~.~, J, .q.ozt.~ ............................................. (Name and title of corporate ofhcer) Builder's License No ...... /.~./.~..~ ............. Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1. Location of land on which proposed work wdl be done. Map No: ..................................... Lot No .................... Street and Number ~ ...DeO~ ,[4~.e..-~A.-¢e.s...~6¢¢i..~e~..L$~.~.,....J..l.~..~ ............................................. Z ;?o 0 Municipality 2 State existing use and occupancy of premises and intended use and occupancy of proposed construction: o Exisiting use and occupancy ....o...~..e..-..~.~...~.~...~.-~...e.~.]...,j:...~.~ .............................................................................. ? · · b Intended use and occupancy ....o..~...e.r.~]~..~.~..],.~.....d..~T.~.]~.~.~ ........ ..C..q% ............................................. 3. Nature of work (check whichlapplicable): New Building.. ................. Addition .................. Alteration ................ Repair .................. Removal i .................. Demolition .................... Other Work ...~.e..~.q.'.z..~.& ............................... (Description) 4. Estimated Cost ...... ~JLS.~.:.'o'.~ ..................................... Fee ....... .~s.J.5.,.Q.0. .................................................................... (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 structu]res, Jf any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ........................... Depth ................................ Height ................... ,. ........ Nu',mber o,f Stories ................................ 8. Dimensions of entire new cohstruction: Front .................................... Rear ............................ Depth ........................ Height .................... Numbe~ of Stories ..................................................................................................................... , '1 O0 ' 200 ' 9. Size of lot: Front ......... .1.0.(~.i ....................................... Rear .......................................... Depth ................................ 10. Date of Purchase ................. . ....................................... Name of Former Owner ........................................................ ! 1. Zone or use district in whichlpremises 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 · ' " ~ ~.~'~Z~ ~"-'"' 0O .o ....................... 14. Nome of Owner of premmes .~,~-C.~8~.(~..~-...(~./.]~.b.$ ............ ~aare'~' ~ ....... deep..... .......... k~o~e.... ~;i~c~e- 298-42?9 Name of Architect ..............i .............................................. Address .................... ,,~ ......... Phone No ....................... Name of Contractor .......................................................... Address ................................ Phon~ No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property ines. Give street and block number or descr ption accord ng to deed, and show streetanames and indicate whether interior or corner lot. STATE OF NEW YORK, ~ ¢ c ................... .~..~...~.~.~..Ze...~.,j,.¢.~f~ ................................................. being duly sworn, deposes and says that he is the apphcam (Name of individual si~ning contrac~ above named. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is d~1y authorized to perform or have performed the said work and to make and file this application; that all statements contained in this appJication are true to the best of his knowledge and belief; and thor the work will be performed in [the manner set fo~h Jn the applica}ion file~ therewith.~ Sworn to be~ me this ,i ~ Notaw Public, ~:,~,~.~~~ , ~.~"'"~'" ~""'~ ........................ ~ .' JUDITH ~ TE~py ~ ' ~ ' / (St~ature df applicant) '