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Home My WebLink About4942-z INSTRUCTIONS ~ : o.-' This application mu~t be completely filled ~n by t~pewriter or in ink und mbmitted in duldlcMe t~ !{~ Buildin~,~i~ Impector. (Nm~m and' title 'of carl:rotate officer) ......................... ................... ...I 2. State existing u~ a~d occupancy of pm~, i~m and Intended u~e, and ~ of ~ eameW, lgtl~n: a. E~sting u. and occul~ncy ...... ..~.~ ........................................................................................... b, Intended use and occupan? ....,.~r, ..................................................................................... / 3 Nature of work (che~k which applicable): New Building - .~'..~.. ........ Addition ................. Alteration ............. Repmr .................. Removal .................. Demolition .................. Other Work (Describe) .................................... 4. Estimated Cost ..~:~--.~.~.~...~. ................................ Fee ...~.~...~ .................................................................. (to be paid on fi~ing this application) 5. If dwelllng, number of ~elling units ...... ~ .............. Number of d~lling units on ~ch flor ............................ If garage; number of ca~ ............... ~..~ ........................................................................................................ 6. If busine~, comme~ial or mixed ~cuDancy, speci~ nature and extent of ~ch ~pe of u~ ........................... 7. Dimensions of existing structures, if any: Front ............................ Rear ................................~pth .................... Height ....................... Number of Stori~ ................................................................................................................. D~mensions of same structure wi~ olterati~s or additions: Front .................................... ~ear ............................ Depth ................................Height .......................... Number of Stories ................................ 8. Dimensions of entire new construction: F~t ...~ ..................... R~r ..~ ............... D~th ..~.~ .............. Height ..J~.~ ......... Number of S~ries ...~ .................................................................................................. 9. Size o~ lot: Front ...~ ............. ~ear ....~...~ ...... Depth ...~.L.~ .............. i0. Date of Purchase ........................................................ N~e of Former ~ner ....................................................... 11. Zone or u~ district in which pre~is~ are situated ...... ~ .......................................................................................... 12. ~s pr~u~ construct;on ~iol~te any zoning law, ordinance or r~ulation~ 13. Name of ~er of premise~~~ ...... Addr~s ~.~c... Ph~e No ..................... Name of Archit~t ............ ~ ..................... A~ress ~ ........................ Ph~e N0 ...... .. ............. Name of C~tracto~~~:...~res~...~.~ ....... P~ No~~ · PLOT DIAG~M ~ate clearly and distinctly oll buildings, whether existing or pr~o~, and indicate all ~t~k dimensions frOm pm~e~ lines. Gi~ st~t and bilk number or description according to de~, and sh~ st~t mine a~ indicate whether int~ior ~ co~r Jot. STATE OF NEW YORK, t e ¢ COUNTY OF ................................ ............................................................................................... being duly {worn, depc 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 Js duly authorized to perform Or have performed the said work and to make ~nd 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 appli~ati0n filed therewith..~ Sworn ........ to before dayme thisof ~. ~' .~ Notar'/ Publ ..... County (Signature of applicant) MARION ,~ REGEN1 NOTARY PUBUC, Stat~ of Hew York No. 52-3233120 Suffolk County :Tlrm i~pir# Ivl~reh 30, FOILM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT? TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING I~EIORIT fi'HIS PERMIT/~usT BE KEPT ON THE PREMIS[~5 UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Z Permissmn ~s hereby granted to: pursuarut to apphcatmn dated .............................. ~e~ ............ ~J~.,., 19...~ end approved by the ..... ~ .... t~7.,.:: ......................... L' Ou~tamg Inspector/ FOILM NO, 1 TOWN OF soUTHOLD BUILDING DEPARTMEN~ TOWN CLERK'S OFFICE ~ SOUTHOLD, N. Y. a ...... .................... , ....... ' " z! 7 Approved ........................................ , 19 ........ Permit No...: ..................... .. Disapproved a/c ....,~ ............ ~ ............... ~ ...... ................. > (Building Inspeetot) ' ........................... Application No ............................. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink und 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 iC'n the diagram which Is 1~3rt of t'his application. c. The work covered by this application may not be commenced b~fo(e issuance bf Building Permit d. Upon approval of this application, the Building Inspector will issus[,a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the progress of the ~ork. 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 Work, and other applicable Laws~ Ordirmnces or Regulations, for the construction of buildings, additions or alterations or for removal or .demolition as herein described. The applicant agrees to comply with oil applicable laws, ordinates, building co, de, h~sing cad, and regulations. ( dd~ess o applicant) State whether app[ic~t~ is own~er, lessee, agent, architect, engineer, generaJ contractor, electrician, plumber or builder. Name of owner of premises ..~ .... ~ ........ ...................................................................... If applicant jsa corpora.re, ~s. Ignore of d~u. ly~horized officer, (Name and title 'of corporate officer) I Location of and onwhch re osedworkw be done Ma No ~~ ' -' 2. State existing use and occupancy of premises and intended use arid occupancy of proposed construction: o. Existing use and occupancy ....................................................... ~ ........................................................................... b. Intended use and occupam:, . .................................................... 3, Nature of wo, k (check whicl~ ooplicoble): New BuHd,ng ,~,....' ..... Addition ................ Alteration ............. Repair ................. Removal ................ Demolition .................. Other Work (Describe) ................................. (to be paid on fi~Jn,o, this application) 5. I.r dwelling, number of dwelling umts ...... ,~ .................. Number of dwelling units on each floor ............................ If garage, number of cars ............... ./.,~....~.~--r,,~¢~. ........................................................................................................ 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 slructure with alterations or additions'. Front .................................... Rear ............................ Depth ................................ Height ......................... Nurnber of Stories ................................ 8. Dimensions of entire new construction: Front ...,,~..~.'~,., ..................... Rear ..,~...,&,, ............... Depth ....~.~. .............. Height ..../~ ............ Number of Stories ...~ifi~,f~,. .................................................................................................. 10. Date of Purchase ........................................................ Name of Former Owner ....................................................... 11. Zone or use district in v*hich premises are situated ...... ~ ......................................................................................... 12. Does proposed construct;on~,,~ ,,~/z~i°l~te any zoning la, w, ordinance,J'~ ,,..-~'~ ~' ,~ or r,~gulation~ ...~.// .................................................. Name of Owner of premise.~,~t~,~.~ ....... Address ~...~'.-.~.~.... Phone No ..................... PLOT DIAGRAM I_ocote cleorly end distinctly oll buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give .,treet and block number or description according to deed, end show street names and indicoPe ~hether interior or corner lot. L STATE OF NEW YORK, CO[JNTY OF ................................ ~' '"'~' ............................................................................................... being duly sworn, dopes end says that he is the applicant (Name of individual signing applicotion) above homed. 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 t~'.a~ the work will be performed in the rnanner set forth in the application filed therewith. ~ Sworn to before me this // : - i ............ : .................... Notor/ Public, ..~...~.~O,,..,,%~,,~vx._.~,~,,~w,~_? ...... County (Signature of applicant) ~ARION A~[ L?FN l [~OTARY PUBLIC, St~te ~f Nrw Yor