Loading...
HomeMy WebLinkAbout3721-z TOWN OF $OUTHOLD' _ ~> BUILDING, DEpARTJ~EN't~ ~ ~ , ~ ' TOW~CLERK'S O~FIGE ~ ~/ ~_sOuTHoLD, N.Y. ~ ~ BUILDING PE~IT -~ ~rl~4, ~ ~ i ~ ~ ~ ~(THIS PERMIT MUST BE KEPT ON TH COMPL~ION OF TH~ WO~KAUTHO~IZ -~ r~ ~'[~'~ ~, ~ ~ N? 3721 Z Permission is hereby granted to: ............ ~.~.....F~z,~%-.-~d....- ............... ...................... ~b~l ~"":~',~:~'"'"'"'" ................ L ~, to ....... ~'~5:"n~ ~n~ ~m~y ot~premises located at ....~/E:~...~]~..OO[ce~..(~l, eG[c..~ ..................................................................... pu~suon¢ to application dated .......................... '~OR~j ....... '~"'*': ...... ; 19...~., and approved-by the Buil~tlng Inspector. Fee ~;'"'3:Oa'00 ........ Building FORM NO. 1 TOWN OF SOGTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E×om ned ....... ........ Approved ........................................ , ~ 9 ........ Permit No....;Y[ .......................... O~sGpp~oved G/C ..................... ~t ~ ~,...., ~;~':~. .................... .%~ ',::~.~:~r~ ~ ...... ~'~ .... .................................................................................... ~ ......................... (Buildin~ ~nspector) Application No. ~ ' APPLICATION FOR BUILDING PERMIT INSTRUCTIONS am 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 propertymust be drawn an 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 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 Buildir~g 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 and regulations. ........ ......... (SignaTure ar applicant, or name, it a corpora~ion~ , (Address of apfRicant) ~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ............ ~ ................ If applicant is a corporate, signature of duly authgrized officer. .................... ................... 1. Location of land on which propased, work. will be dane. ~Map No: ....................... ~ ................... lot / ~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed ~:onstruction: a. Existing use and occupancy ................................................................................................................................... b. Intended use and occupancy ............. ,...~.~.~.~. ................................................................................... 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .................... R£)'noval .................... Demolition .................... Other Work (Describe) ...................................... 4. Estimated Cost .......~'~..~...~..~t~..~...'~.. .................................. Fee .......................................................................................... (to be paid on filing this application) / 5. If dwellin~j, 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 ............................ 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 ?~1/' Rear '7'~' Depth ...... ~...~. ................ Height /~ ~ ............................ Number of Stories ............................ · 9. Size of lot: Front ...... /...~......r. .......... Rear ......... ./...O~... .......... Depth 10. Date of Purchase ..... 0..r,~'.. .......... ~.~,..~....~.. .................... Name of Former Owner ........... ~--~b../7~......~ ...... 11. Zone or use district in which premises are situated ................. .~.. ............................................................................ 12. Does proposed construction violate any zonirlg law, ordinance or regulation,? ..... .,~....O. ......................................... ]3. Name of Owner of premises ~i.~..~.....~. ......... Address ./.~..~...'~.~¢,~./.~.~..~.~.~......~.....~...:~o~e No~...~..~..~.."...~...7...~.~ Name of Architect"~l~...~ ...................... Address ~..~.~.~...~..~.....~....'~one N .~...0.."..(.:.~..~..~....~' Name of Contractor .................................................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions fram property lines. Give street and block numbers or description according to deed, and show street names and indicate _ ~q~e__t,.,.er~ ~ inte_r_ig£~o.r.~cpZ~e~r~l.9._t.: .................................. STATE OF NEW '~(-QRK~/') . /1 rS S J O~NY C K-~'~'/( cOUNTY OF ..... (Nome of i~(dividuSI sig~i'~' app icotion) ....... being duly sworn, deposes end soys that he is the applicant 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 performed in the manner set forth in the application filed therewith. Sworn to bede me this ,, ~ ,/~, ~ ............. .)¢...~. ...... day of n..~ ~.¢~/~:;tJ:;~0],9-~.,2 J) /I -/- ~. ~ /'~, /, Notary Public, ......~~t~~~_' '~i'~'~-~t~u'~"/~"'(~'~~ ......................