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HomeMy WebLinkAbout480-zExamined .............................................. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ 19 ........ Permit No ............................... Application No ............................. Disapproved o/c ............... :..'(~r .................. :~"~.. ......... ...~.,.~r~ ........ ~ ..... ~.~ (Building Inspector) ~ APPLICATION FOR BUILDING PERMIT Dote ...................................... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and su~omitted in duplicate to the Building Inspector· 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 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 appllcant. 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 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 a Iterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. (Signature of applicant, or name, i a corporation) .... ........ (Address of applicant) State whether applicant is owner,~~t, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises .......................................................... , ................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which, proposed work wdl be done. Map No ...... :_..~. o No .................... Street and Number ' ~..'~.. ........................................................... Municipality 2. State existing use and occupancy of pr, emif, e~ and intended use and occupancy of proposed construction: a. Existing use and occuponcy .................... ~..~ ........................................................................ b. Intended use ond occupancy ................................................................................................................................ 3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost .............................................................. Fee ..~.... (to be paid on filing this application) 5. If dwelling, number of dwelling units .......... ~ ....... Number of dwelling units on eech floor ............................ If garage, number of cars ............................................................................................................. - ............................... 6. If business, commercial or mixed occupancy, specify nature and extent of each tpe of use .............................. 7. Dimensions of existing structures, if any: Front ........ .".~.......~.....: ..... Rear ............... ~'....~...... Depth ....'.~.....~........-Z. ........ 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 / z~ Depth Height ............................ Number of Stories ............................ 9. Size of lot: Front ............................ Rear ............................ Depth ............................ 10. Date of Purchase ......... ~. ~/~ .... Name of Former Owner 11. Zone or use district i~ ~'~i~h'~i}}}' ~';~' ~ii~ ....................... 12. Does proposed construction v~:~ate,4~ny.~z,~onlng law, ordinance or regulation? ......... ~ .................................. 13. Name of Owner of premises. Y..:...~.: ............... Address ............................................ Phone NO ..................... 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 numbers or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW,~YCJP~,~ ~. ) S S COUNTY OF ..~¢-,-,-,-,-,-,-,~..~..__...) - -',q , . ,. ...........................~/~ )"~ J~ ..~./.~.~...~.being duly sworn, deposes and says that he is the applicant (Name of individual signing application) ~ _ above named. He is 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 all statements contained in this application are true to the best of his~now[edge and belief; and that the work will be performed in the manner set for~. in~agplication fi~t~rew~.)~ ~ ~ b~re~et ' . ,. '., - TOWN OF SOUTHOLD Town CLER.'S O.,¢E SOUTHOLD, FI. Y. Examined ......... Approved ........................................ 19 ........ Permit No ............................... Disapproved a/c ............... ............... (Building Inspector) Application No.......~,..~). ......... APPLICATION FOR BUILDING PERMIT Date ............ .~.~/!~'..~.:;:'.':.~.....i'.:..~ ...................... 19 ~ .C.~ ..... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and su~)mitted 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 sholl 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 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 issuanoe 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 and regulations. (Signature of applicant, or name, if a corporation) ~ '~ i-~ )~, ~ ~ i L~. ~'l. .~ L, fiji ~ 11 (Address of applicant) State whether applicant is owner, le~f.~ee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..................................................... ,¥,~'.~;~,,,,,~,~?...,~,..,~','. : ........................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on whi~h~.proposed,work~ .-..--.- '.~i~") be. done. Map No:. . . Lot No: Street and Number ...).:i?.:':::.'.2:;....'.~...':......:'~i.~:').'::~'.-..:.:;~: .................. .~',~:~..?:.;:..'.~.~:~.'.~.:~.~.:..:~::,i ..................................... Municipality 2. State existing use and occupancy of premises,, 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 ....... ~....'..Alterafion .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4~ Estimated Cost .......... ~.... ................................................ Fee ........................................................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units .......... .C..~.¥...'~....-: ....... 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 ....~...~ ................ 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 ...... .~i..~':T. ............. Depth ,../..~'~'i ................... Height ............................ Number of Stories ............................ 9. Size of lot: Front ............................ Rear ............................ Depth ............................ 10. Date of Purchase .................. I...f.....'..S;~. ...................... Name of Former Owner ........................................................ 11. Zone or use district in which premises are s~tuated ............................ ,.t.,~'.¢.~.. ................ .%... ............................... 12. Does proposed construction vipbte any zoning law, ordinance or regulation;~ .......... ~ ...... /~j ,,// 4// , ............................. ]~. Name of Owner of premlses..'~.:...~,L~ ....... .....~ ............ Address ............................................ Phane NO ..................... Name of Arckitect ........................................................ Address ............................................ Phone NO ..................... Name of Contractor .................................................... Address ............................................ Phane 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. STATE OF NEWe-YO, RJ~,o t~d,, ) S S COUNTY OF ....~..'¥,~,~.~,'.5',:,~.,.) ,,'/? ,, 4 71' :. A, /,, / ,, fi' '/- .............................. ~.~.n4.:'~:::'L:/..:.::..:::::':.fi...::.';:.t...::..: ............ be.ng duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is 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 all statements contained in this application are true to the best of his~,knowledge and belief; and that the work wdl' be performed in the manner set forth in the Sworn to before me this .~, - ~ .... ~0~ /~ f ~.~ ........... i.. dav of .......................... 19. suffo~ ~ure of oppncant/