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Home My WebLink About2436-zFOBM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No. ~...~J..~.~..~' .......... .~ " APPLICATION FOR BUILDING PERMIT Dote ........... ................. , INSTRUCTIONS a. This application must be completely 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 public streets or(~ areas, and giving o detailed description of layout of property must be drawn 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 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 pa rt 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 and regulations· _ ~J~;~;;~';~'Opplicant, or name, if a corporation) ....... ..... ..... (Address of 9pplicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of ,~rem sas ...~.~ ~.. AH ~ ~t rl~ '~ta~l'l.,~lO If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done· Map No: ............................................ Lot No: .................... Street and Number ...... ..~.../i...~....~. ............ ..~....~.'.., ............ ~....~....T..~.!i~..~...~x, ........... .L.....-~...L...~...~... ............................ '~/ ~ / ~ ~ l~) ML]nicipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: · a. Existing use and occupancy ....~....~.(~.~..'~..~ ..~...Igg= · ................. : .......................................................... ntendeduseandoccu anc ~'~-I~TE ~.~ JO b. p y ........................... A .......................... ~ ............................................... ..:: .......... ,/ 3. Nature of work (check which applicable): New Building ........ ~. .....Addition .................. Alteration .................. Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................ 4. Estimated Cost .....~.....Z.~. ~?..L.F~.. .................................. Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ..~...~..~...S..Z..~...~./~.T.~...Number of dwelling units on each floor ..~...6.~....~..~..~...~/..~..~ If garage, number of cars .........~ ................................................................................................................................ 6. If business, com~rcial or mixed occupancy, specify natureand 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 n~ construction: Front ~ Rear ......... ~.~ ............. D~th Height ....... ~....~.~ .......Number of Stori~ ..........( ....................... 9. Size of lot: Front ~ 00 Rear ......... ~.~ ................ Depth 10. Date of Purchase ........................................................ Name of Former ~ner ............... ~ ........................................ 11. Zone or use district in which pr~is*~ oro situotod ....... ~(.~.~.~.{.Q.~. .................................................... 12. ~es proofed construction violoto o:ny ~onin0 Iow, ord nonce~r renu ot on? ....... ~.~ ........................... 13. Hame of ~ner of premises ...r~..~.~:.,..~[2~{~H.~ Phone No. ~.~.~z.~.~ ~ Ih~ Name of Architect ............................................ : ......... Addr~s ......................................... Phone Name of Contractor .~....~.J.'..Z....~....t~...~.f~.(.~.~....Address ........................ : ...... :..: ..... Phone No.,~.. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate oil set-beck 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_YORK . ) COUNTY Of s.s. .............. ..~.'~./~.]g........~..: ...... .~.....~../~...~.. ................................ 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~ir~.t~[l~pplication are true to the best of his knowledge and belief; and that the work will be performed in the~m~r~t~r~eHe~f6'~'h in,the application filed therewith. ~', . . .~, he 52-;34.4963, Suffolk County ./ . ~worn to De?ore me Tnls (:om ........ ......... ........ ........................ Nota County ...... ............. ............................. FOR~I NO, ~ 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 AUTHORIZED) N? 2~36 z Permission is hereby granted to: · To.l~..~ ..l~.e~. ~.J~:r.~ ...................................... ........ .?....~...~.~.~ ....................................................... ............... ~.~.t..~.e.~ ........................................... to ~...~..u!....1..~ .. ~.e..w.....°...n..e., .~.~..&~....~l.w.e.:. l&r~ .-...{:on.. ~-e~.-. 1~0~. ....................... at premises located at .......~....~.~.....~.~ ............................................................................................... ~att~tuck~ N.~. .. pursuant to application dated ............. ..~...1~..~ ~ , 19~A'..., and approved by the Building Inspector NOT~I Bu:],ldlrtg shoul,~ be 3~ baek of 130f~ dtvtdt~ line ~d not closer th~ loft to s~de l~ne. F~ ..... ........... ............... Building Inspector '"[ " TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exam,ned' ....~ ^p roved ................... Disapproved a/c ....................... ............. ..................... : .................. (Building In.~ector) APPLICATION FOR BUILDING PERMIT Date ..~...'~..'~ ~' ¢ / .................... ,' 19...~...~.~.. INSTRUCTIONS a. This application must be completely 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 public streets or areas, and giving a detailed description of layout of property must be drawn 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 progress of the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until o Certificate of Occupancy shall hove been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment 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, :..~. igulati°ns' The applicant agrees to comply with oil applicable laws, ordinances, building code and r i n~ure of opp 'c , or ame, if a c;rpora~'i'~;) ' (Address of applicant) State whether applicant is owner, lessee, agent, architect, engi,neer, general contractor, electrician, plumber or builder. .. . applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Location of land on which proposed work will be done. Map No.: ........................................ Lot No,: Street and Number ~: ': C~ , / ~ ~ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..................................................... ~.. ............................................................ b. blended us~ ~nd occup=ncy ............................. ~ ................................................................................. 3. Nature of work (check which applicable): New Bu~ d~ng .................. Addition .................. Alteration ................ J.. Repa.ir .................. Removal .................. 'Demolition ............... :.. Other Work (Describe) ...................................... 4. , (to be paid on filing this application) If garage, number of cars .......................................................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ...... ~.. .J.. 7. Dimensions ofexistingstructures, ifany: Front ............................ Rear ................................ Depth DH~m~gehnts ~ins ...................... of same struNc~ew~ i! aS[t°erlae:i ions ...................................................................................................... or add' .~.] ......................... Rear .......................... ','""}" Depth ................................ He'g ............................ ' ................................ 8. Dimensions of entire new construction: Front ....... .~..~..! .................... Rear__.~..~.! ................ ' / I Height ....... /..~.~ ..... Number of Stories ....... ../. ........................................................................................................ 10. Date of Purchase ........................................................ Name of Former Owner ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ......... ./.~..~.. ........................................ , Name of Architect ..............~.~.~.~ ............................ Address ............................................ Phone No .................. J.. PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate all set-back dimensions frdm property hnes. G~ve street and block number or descnphon according to deed and show street names and ~nd~cdte whether int'erior or corner lot. ' STATE OF~ NEW YORK, ~ ~ c COUNTY OF ................................ ~ .... ................................................................................................. being duly sworn, deposes and says that he is the appliclnt (Name of individual signing application) above ne.med. He is the ....... ..~...~..~..~,..f~.. ............................................................................................................................. ~ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly auth~)rized to perform or have performed the said work and to make and [ile th s application; that all statements cont.ained in this application are true to the best of his knowledge and belief; qnd that the w~brk will be performed in the manner set forth in the application flied therewith. 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