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Home My WebLink About3910-z FORM I~.0. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT fi'HIS PERMIT MUST BE KEPT ON THE PREMISE~ UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 3910 Z Permission is hereby granted to: Building Inspector. APPLICATION FOR BUILDING PERMIT '~' ..... ......................... .... 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 pmperty~nust be drawn on the diagram which is port 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 oFthe work. ' e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy sholl I~ave 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 appli?..a, ble Laws, Ordinances or Regulations, for th~ construction of buildings, additions or alterations, or for removal or demohtz6n, as herein described. The applicant agrees to comply with all applicable laws, ordinances; building code, housing cede; and regulations. (Signature of~pplicant, or name, if a corporation) (Address of applic;3~t) , , ' ....... State whether applicant is owner, lessee, agent, architect, engi.neer, general contractor, electrician, plumber or builder. Name of owner of premises ..~..~.ZL~,.....~.....~.~-/~..~...~,....~...tYC~ ........................................................................................ ~ If applicant is a corporate, signature of duly authorized officer. (Name and tlt!e of coi'porate officer) 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No.: ........................ Street and Number ......................................... ~..~. ............................................................................. ~'! ~ //,~ D Municipality 2.State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....... /~.~..~...4~....T./~Z ............. ............................................................................... b. Intended use and occupancy ..~.0.~6¢~.~,,.~./.....~'J~.~.~.~/~/~Sf:' ....... ~.,~3~ ................... ~ ....... i ........... 3. Nature of work (check which applicable): New Building .i...)~. ......... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. ~timated Cost ................................................ :..Fee .......................................................................................... (to be paid on filing this application) §. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ rnbe · If garage, nu r 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 ....~.~ .............i"...."i ................. ............................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ,..~..?./....?...O./.....~....d/..~,.~--/-- ---- -- Rear ....~ ....... Depth ./..~...8/./'.0.~../.~.~?g Height .................... Number of Stories ......... ~ .......................................................................................... 9. Size of lot: Front ,...~....O.:..~.~.~ ....... Rear ...;?,..o..o..: ....................... Depth g.e~...Z...l..~/:.~..~.....~.¢~' 2. ~/~,dg' 10. Date of PurchaSe ....J~....~..~.~...~'.~.~,-/.~.)../..~.~..?. ...... Name of Former Owner ..~........~.~.~.~.~. ............................. 11. Zo,.ne or use district in which premises are situated ....... ~ ................ ; ............ 12. DOes propOsed C0nstrbcti°n violate any Zoning law, ordinance or regulation? iiiiiiii~i~..iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiii 13. Name of Owner of premises l~/~.~.~..r)~...~FE.~.....Addressl~J.~...~...~.F~,F-.E~gZ'~.~.. Phone No. Z.~'~..'~. .... Name of Architect .............................................. ~ ....... Address ............................................ Phone No ..... .~ ............... Name of Contractor ............................ ~ ............... Address ................. ; .......................... Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all. building~hfdtiClllr~existi~//o~p~d,-- -- anc~ indicate all set-back dimensions from property lines. Give street and blo~k number or description according to deed, and show street names and indicate whether i~terior or comer lot. 'e$$~oo" 2. oO, ~'9~ ~ STATE OF NEW~t~ORI~, I. t c c ............................. :~c;,,&~,,~n,.,,~,,,~......2 ............ ...being duly Sworn, deposes and says tho~ he is the applicant (Name ~F. individual sil~n~gr~ ~,~J~., ,,applicati°n) . 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 will be performedin-themanner set forth.in theapplicatiorr filed therewith. Sworn to before me this ~ · .................. day of ............ ........... , Notary Public,~..~...~.~.../~ounty .................. ~g"~i~/';l~'~l~ii~'~:)' ............................. No. 52-3233120 Suffolk Caul,be.