The URL can be used to link to this page

Home My WebLink About5482-z ~0. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y, BUILDING FElt. MiT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5482 Z Permission is hereby granted to: ................. ~..~ .................................. at premises located at ........J~IL~.~IIL... ~Ta~lt. lJ...~ ................................................................. ...................................................... l~el.l.~.A~.e ................... ~ ............................................. pursuan~ to application dated ............................ .~....~ ............ ~ ........ , 19..~...,, and approved by the Building Inspector. ~ee $.-~. ........... lrOt~M NO. 1 TOWN OF SOUTHOLD BUILDING DI~PARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ....... 19.2..l. Approved ................ ~..~.........~...!......, 19.~..(.. Pemit No....~..~....~....~ ..... Disapproved a/c .~. (Buil~ APPLICATION FOR BUILDING PERMIT Date INSTRUCTIONS 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 o areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which Js 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 t~ 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 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, building code, housing code, and regulations. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant i~wn~,, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name 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 will be done. Mop No.: ..................... Lot No ........ Street and Number ......... /.~.~.......~..~.....~:~ ....... ~....~.. ........................ ~.~.~..~.~.~.,.~..~.. ................................ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy ........... ~..~.../....?.~...~....~...~. ...................................................................... b. Intended use and occupancy ..................... ,,,~..~..~......,~,~.,.~___~1. ....... ,'Z-.~.....~ ....... ~,,.~,~ .............. 3. Nature of work (check which applicable): New Building .................. Addition f Alteration Repair .................. Removal .................. Demolition....~ ............. Other W_ork (Describe) ........................................ 4. Estimated Cost ....... .~..~..~....~.. .................................. F~e .' .................. .~../..~. ............................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ............ ~ .........Number of dwelling units on each floor .............. ' .............. If garage, number of cars-, ............ ~ .......................................................................................................................... 6. If business, commercial or mixed occupancy, speci~ nature and extent of each type of use ............... ~ ............ 7. Dimensions of existing structures, Jf any: Front .............. ~==. ......... Rear ..................... ~-'; ......... . Depth ~ Height ......... ~-.;.;. .......... Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ...... .: ............................ Rear ......... ~ ............. Depth ................................ Height ................ .'..-~........Number of Stories ....... ..-T~...; ................... 8. Dimensions of entire new construction: Front ............ ;~.. ................... Rear ..... /.~, ................ Depth ..~....~.. .............. Height ....... .~...../. ..... Number of Stories ......... /.. ......................................................................................................... 9. Size of lot: Front ........./.~....'~..../. ..... Rear ......... ./.~....'~...../.. ........... Depth ....... ../..~....~...../.. ......... 10. Date of Purchase ................................ ~ ................ Name of Former Owner ................ .' ....................................... I1. Zone or use district in which premises are situated ....................~.....~..~..../....._~.....~.....,~......,~.../.~......A~... ............................. 12. Does proposed construction violate any zoning law, ordinance or regulation.;> ................ ~....~... ................................ 13. Name of Owner of premises ...~.~.~.....~....~.......~..~./....~A. ddress ../~...'~.......~..~...~.......~....~.. Phone No.~...~....d.'~.~.~..~' 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 number or description according to deed, and show street names and indicate whether Interior or comer lot. COUNTY OF ..~,l~,~,O.~,~ ............ .... ~.t~t..~ ........... .E~nlc..l'.e~.;L~.~...;. ....................................... being duly sworn, deposes and says t~t he is the applicant (Name of individual ~igning application) above named. He is the ..... ~ ........................... ~e~...~...~o~ ............................................................................ (Contractor, ag~t, co~orate officer, etc.) of said ~ner or owners, and is duly authorized to perform or have performed the said work and to ~ke 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 fo~h in the applicati~ filed therewith. Swam to before me this ~ ...... ~O.~ ........ day of ......... ~.....: .......... , 19...2~. ~ ' ~ ~ _ / J. ............ ............... Nota~ Public~.~~~ ..... Coun~ o~ S~o~ (Signature of applicant) NOTARy PUBLIC, SLate o~ ~w No. 52.81258~, Suffolk Term Expires March 30, Co