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Home My WebLink About10171-z FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 10171 Z Permission is hereby granted to' (r~/'~ ! r',~ ,~/,s , , ) ...:~.~/~....~=..~_%~ ... ~.~ ~ ~ ........ .......... .... ; ......... ~~...~..~: ............. ~o ..~/~:~.z..~' ....... ~.=~..:: ...... ~Z~.~....~z~...' .~.m.c.~z~ ................................. pursuant to application dated ............... ~....-?.....~...~.. .................. 19.7..~'., and approved by the Building Inspector. ...... (" Buildingi/fnspector - '~:- FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved .... .~.~/..'~. ..... , 19 2 .~Permit No./(.~./.. Application No.../~J .~'..2.[ ....... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be compl,etely 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 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 B,uilding Permit. d. Upon approval of this application, the Bmlding 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 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 inspection~.,,,,,~.,- ....... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. Name of owrier of premises ....~..C......,J.~a~--~....~..o..oc....'-...'-~....c~....c2d0.~.~. 'i ............................... (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....~. ?.,,;:D .................. Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... t. Location of land on which proposed work will be done ................................................ ................... ............................... 0. ...................... House Number Street Hamlet County Tax Map No. 1000 Section .. ~).~-~ .~. ........ Block ....O. ~,~ ......... Lot..~O...~../.~ .-~.. Subdivision ............. .-:' . .................... Filed Map No. .; .'7 ': ......... Lot .............. (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy.. F. rT~..c~..e...~ :.~ ........................... ~ ............ b. Intended use and occupancy.. ~./~... ~ ~.-,.~----~.,ef,,~'~..~/~'.~ .~-'~,4~..~...~...'7 ...... 3. Nature of work (check which applicable): New Building .......... Addition .......... Altera~on .......... Repair .............. Rembval .............. Demolition .............. Other Work .'~?... 4. Lshmated Cost Fee .... /.~.. ............................. (to be paid on filing this application) 5. ]f dwelling, number of dwellingmnits ............... 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. D~ensions of existing structures, 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. D~ensions of entire new consffuction: Front ............... Rear ............... Depth ............... ltei~t ....... ~ ....... ~ber of Stories ................................ 10. Date of Purchase ....... ' .................. Name of Former Owner .............................. 11. Zone or use district in which pr~mises are situated ................................... ~. ................ 12, Does proposed construction vie,late any zoning law, ordinance or regulation: ................................ 13. WilI lot be regraded ..... ~. ~ .................. Will excess, f~ll be removed from premises: Yes No 14 ............. ncr ~f vrem~ses .... ~ ............ ss ..........................." N~e of Architect ....... ,~.. . Address ~ ~' ~.~gi2 }~. '~ ' ....... ~ ~ ~ Phone No. Nme of Contractor ~.~[ g; ~;~/~;~Address PhoneNo. ~5~ Locate clearly and distinctly ali property lines. Give street and blocl~ interior or corner lot. PLOT DIAGRAM buildings, whether existing or proposed, and, indicate all set-back dimensions from number or description according to deed, and show street names and indicate whether STATE OF NEW ~OP~K~ , ~ ~ S S COUNTY OF . .~~......'r-r~ ' ........... .~(-~~...'ffH~.~ .......... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ..................... i .................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dt~ly 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 ......... ./(..~. ........... dayqf..~ ........ Notary Public, . .... ~ .(-x-. ............. County I~,t~?~,~ ¢. 'c'o'i~hb[,' ' (Signature of applicant) l~OT~[lty PUBLIC, gtr~te of New Yorl~ Suffolk County No. 52-$792800 ComrnLqsion Expire., M~rch 30, 19 L N. ~,°15"5'0"~, ¢'0