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HomeMy WebLinkAbout430-z TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .................. 19.. Approved ........................................ 19 ........ Permit No. i~..~i.~ .... Disapproved a/c .............................................................................................. Application No .........~....,,~.....0.. ........ (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ........... ~.....:~ 2. .................................. 19...%..~ .... INSTRUCTIONS a. This application must be campier, ely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to .adjoining premises or punic streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this location. 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 progress of the work. e. No building shall be occupied or used in whole or in part for any pu~'pose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuanc.e 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 a Iterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicoNe laws, ordinances and regulatlons. (Sighs}ute of applicant, or name, if a corpora'ion) .................. (Address of app~nt) State wheth,er applicant is owner, lessee, agent, architect, engineer, genera~ contractor, electrician, p~umber or builder. ........................................ ' Name of owner of premises ...... ~.,,..~:~,~~,,,..,~ ....... -..v..~J;.:.;:~~ .............................................................. If applicant is a corporate, signature of duly authorized officer. (Name an, d title of corporate officer) 1. Locationofla~donwhichproposed~orkwillbedone. Map No: (,~...~/'.;~:=/?i~..[~c.~,~.h~.::~i~.CLot No: ...'.?.~ ...... ^ // c/ c . -e 4', Street and Number ...?.:/../..:.'~ ...... l,,,...f...-~:~...:~.¥~.% ...... /.~-~..'~¥-'}.--'~...~=.~-.'?:.....%. ~ .......... :'.: ......... J ........................................ Municipality 2. State existing use and occupancy of p,r, gmises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....................... ?...,.; ........... ,~ .......................................................................................... b. Intended use and occupancy ............................................................................................... ; ................................ 3. Nature of work (check which applicable): New Building .................... Addition ................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... ,~ ~.~'O '. ......................... 4. Estimated Cost .............................................................. Fee .: .............................................................. (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 structures, if any: Front ........ ./...~. ............ Rear....../.....(? ............... Depth ....~...C ............... Height ............................ Number of Stories Dimensions of same structure with alterations or additions: Front ................................ Rear ................................ Depth .............................. Height .............................. Number~ of Stories ................................ / 8. Dimensions of entire new construction: Front ............... ~..~ ...... Rear Depth :.. ~....... Height ............................ Number of Stories 9. Size of lot: Front ....... ~..~....~ ...... .~ear ........ ~.~..~ ......... Depth ...~..~...~:....../) 10. Date of Purchase ........................................................ Name of Former,.Owner ...w....-,~, ...........:...,~.:q.. .................... 11. Zone or use d~str~ct ~n which premises are s~tuated ....................... ~M..~.~....~,~..:.. ...... := ................................... 12. Does proposed construction v[eJate any ~oning law, ordinanc~ or r~ulation? .................................................... ....... ........ ........................ ..................... Name of Arch tect ........................................................ 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 numbers or description according to deed, and show street names and indicate whether interior or corner lot. ...... ,... J?/~ V~ ]~ O ~,~;~.,~*~r~ ,..,r STATE OF NEV~YORK~ ,~/ ) S S COUNTY OF ~'/<t:i,'.b./...c~.. ) ' ,i"- ?":" ......... t~ :f, /:.i" , . ...................... (Z:.~:.:~..:::.?T..v~..;.~.~....'.~.~..?..:;:..~. ..................... being duly sworn, deposes and says that he is the applicant (Nome of Xindividual signing application) above named. He's the .......................... ~ .............................................................................................................. ~'~'~ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that a~l 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~rth in the application filed therewith. .., ' ........ ............... · .