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Home My WebLink About10207-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 COMPLETION OF THE WORK AUTktORIZED) N? 10207 Z Permission is hereby granted to: ...... ~,~TL.~c~.z:...~......L'Z'~<..~. · k~.o.:.~.~.Z.~.~...i~Z~.~ ............... .... ......... to ...~..~.~.~ ~(~ ........ ~..~ ....... ~.~..z~.~...~.~.~= ............................ pursuant to application dated ........ .~..:.-.-,-'~.-....~.. ............................... 197.,,,~.., and approved by the Building Inspector. · / Building- Inspector FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined. ~. ..... , 19 .x/.~./~ ^pproved . .?:. ...... , l 77PermitHo. /. O. .O. .?. // Disapproved a/c . ........~ . ....-'--~. ........... ~ ......... // (Bu31/ding~ Inspect or) Application No...f.c~.~.~. 7 ...... 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 a detailed description of layout of property must be drawn on the diagram which is part of tkis 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 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. ,7 --~ ........ .. . F!g re?plicant, orname, iracorporat!on) gx, ............... .............. - ..... .,.... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................................................... :'. ................... Nam e'~f owner of premises ~/~. ~..' ~.'~"~'.~.. ~'~.://.~.~.ff~..~. f.d?..~..7~.~.~-'/.7"-' (as on the tax/oi1 or latesffde~ ~){ If applicant is a corporation, signature of duly authorized officer. U' [' (Name and title of corporate officer) 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 will be done.. ~;~. House Number Street Hamlet County Tax Map No 1000__ _ ~47/-,~_]S/gectl°n '' '~'~Z'~' Block ~-~ ~ . ' .... ~: .... . ..... ~ ......... Lot ..............) Subdivision ,//~. ~ .... ~::~7~~:~'~iled Map No ... J.':~ ~- .... Lot ...... ~ ....... " (Name) ~' State existing use and occupancy of premises and intended use and o~cupancy of proposed construction' a. Existing use and occupancy . .~, ..... ~ .......................... - ......- .................................... b. Intended use and occupancy . .~-.~ C~Z~ ......... 5. ...... '7 .................................... : ratio~ 3. Nature of work (check which a~plicable): New Bnilding .......... Addition .......... Alte ....... Repair .............. Removal ............ Demolition ............. Other ,~/? ~ /~_5- scription) 4. Estimated Cost .... ~.~'. .... I ....................... Fee ...................................... i (to be paid on filing this application) 5. If dwelling, number of dwelling .units ............... Number of dwelling units on each floor ................ If garage, m~mber of cars 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structur6s, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stones ............................................ Dimensions of same structure wlth alterations or additions: Front ................. Rear .................. Number of Stories Depth . Height ' F Depth 8. Dimensions of entire new construction rent ............... Rear .............................. Height ............... Number of Stories ........................................................ 9. Size of lot: Front .......... , ........... Rear ...................... Depth ...................... 1 0. Date of Purchase .......... ! ................. ~Name. ofrFormpr. Ow23er ............................. 11. Zone or use district in which pr~mises are situated../Z~.d~-¢..~. · .t?-'Z%'.. ~-&A~..'~. ..... _. ......................... 12. Does proposed construction violate any zoning law, or&.n, ance--- or regulation: .... ~ ..................... Name of Architect ......... ~'. ............... Address ................... Phone No ................ Name of Contractor ......................... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, 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 interior or corner lot. STATE OF NEW ~J~ O YOF. : ~~~k ~. ~~~: ~ing duly sworn, deposes and says that he is the applicant /'(Name ofindividua signing contrac above namtd. He is the ~~ " .................... ;: ...... ~ ......................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly authorized to perform or have performed the said work and to m~e and file this application; that all statements coniained ~ this application are true to the best of his knowledge and belief; and that the work w~I be perfo~ed in the m~er set forth in the application filed therewith. Sworn to before me this ..