The URL can be used to link to this page

Home My WebLink About5251-z· BUILDING DIFARTMIENT TOWN CLEI~K'S OFIIICB SOUTHOLD, N. Y. APPLICATION FOR BUILDING FERMI1' INSTRUCTIONS a. This application must be cOmPletely ill'led in by typewriter or in ink -,nd sUbr~itted In duplicate to the Building Inspector. b. Plat plan showing location of lot and of buildings on premises, relationship to adjoining premises or public st?ets or areas, and giving a datai]ad description of layout of pmparty must be drcnvn on the diagram v~ch c. The work covered by this application may not be commenced before iseuance of Building Permit. d. Upon approval of this application, the Building Inspector will Issuea Building Permit to the applicant. Such permit shall be kept on the premises available for Ir-~oaction throughout the progress of the wor~. e. No building shall he 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 Dep6rtment for the issuance of Building Zone Ordinance of the Town of Southold, Suffolk County, New Y. ork, and other .ppplJceble L.av~., .OMi,norm.es. Regulations, for the constr,,ction of buildings, additions or al.terations, or tar removal Gr aemalltion, al nam,n amcr,oea. The applicant agrees to comply with all applicable laws, ordinances, building code, (Slgna(rure cf appllcant,/~' name, If a r,o~Immtion) ) "'"'"' ............ ....... :r ......... State whether applicant is owner, lessee, agent, architect~?nglnalr, general contractor, electrician, plumber or builder. Name of owner of premises~~ ......................................... .<~. If applicant Is a corpo e, si oture of ly' authorized officer. ~ (Name and title 'of corporate officer) ~ ~ ~ I. Location of land once,which p~q~ ~jrk_work will_ be ~-,d°ne' Map No.: .................... /~ ................. Lot No'~& ..~" .............. 'j,~. - )~ Municipality -- ,. Stat..x,st,ng / e occupancy of premises and intended use and occupancy of propeeed aonstn~.'tlon: a. Existing use and occupancy ...... ~ .~..~ ............................................................................................... b, i~tended use and occupon? ,,.,,.~ ......................................................................................... 3. Nature of work (check which applicable): New Building ~.~ ...... Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................. Other Work (Describe) 4. Estimated Cost ..... ~ ..~.~.~k~. .................................. Fee .~..~. ....................................................................... (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 cora ..~¢a~.... ...................................... -- ~ ........................................................................... 6. If business, commercial or mixed accupancy~ 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 olterotions or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ..... ~.~:~ ........................ Rear ....~.~. ................. Depth .-~...~... ............... Height .~..~../. ......... Number of Stories ....~ ................................................................................. 9. Size of lot: Front .~..d~. ................ Rear ....,~...~...~.. .................... Depth .../~..~.....--...,~..../..8.. ...... 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ ! 1. Zone or use district in which premises are situated ..... ~.~,,~ ................................................................................... 12. Does praposed construct'ion violate any zoning law, ordinance or regulation? ..~. .................................................. 13. Name of Owner of premis~~q~..~....Address ............................................ Phone No ..................... Name of Architect ....s ........... ~ .......... ~, ........................ Address ..... ., .................................... Phone No ..................... Name of Contracte¢~..'~.~..~.~~ ............. Address~...~...~.'..... Phone No .................... PLOT DIAGRAM I.~ate clearly ond di~il~:tJy all buildinga, whether existing or prapoeed, and indicate all set-back dlmer~ions from property lines, Give street and black number or description according to deed, and ~how street names and indicate whether Interior or comer lot. STATE OF N~mWO'OIJ~,e~ ' lee COUN, ..... .................. :,. ............... .~J~C,~,,t, Je{~%.....~ ........ being duly ~orn, d~s and says t~t he is the applicant o~ve nom~. H~ i, th, ......................... ~.~ ...................................................... ~2~ ............. ~ ...................... (~tmctor, ~t, co,orate officer, ~c.) of said ~r or ~ners, and is duly aut~rized to ~orm ~ ~ ~rf~ ~ ~id ~rk a~ to ~e ~d file th~ ~licoti~; that all statements contain~ in this applic~i~ am tree to ~e ~$t of his kn~l~e a~ ~lief; ond that the w~k will ~ ~do~ in t~ manor ~t fo~h in the ~IM~i~ fi~ ~i~. ........ ... .. ~ N~ARY PUBLIC, ~ ~ew York FOR.,~ 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? 5251. Z Permission is hereby granted to: to at premises located at ~ }~'~zz ~e~' ¢,~ ~y"~e~' ........................... ....................................................... o~t,~l~l ..................................................................................... pursuant to application dated .......................... A~i],. ......... ~..!...., 19....~.~, and approved by the Building Inspector. Fee $.l.Q,rlO ........... Building Inspector OF souT"oLD BUILDING DEFABTMENT TOWN CLERK'S OFFICE SOUTHOLD, No Examined ........ ~.~.....~..( ......... , 19...2/.. ^pproved ........................................ , 19 ........ Permit No ....... Disapproved a/c ........................ ............................. Application No......'~...~....~....~ ............ APPLICATION FOR BUILDING PEP. Mr/ ,! 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 premisas, relationship to adjolnlng premiee~ or publl~itreets or areas, and giving a detailed description of layout of property mustbe drawn on the diagram whtch 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 Deportment fqr the issuance of o Building Permit pumuant to the Building Zone Ordinance of the Town of Southold Suffolk County, New York, and other applicable I.awl, 0rdlnances 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, sing and regulations. -- --(S]gngKi~ 6f ap~licant,~/' name, If a corparatlon) // "/ - ' (Addree~"ofapp!lcant) ' / State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (Name and title'of corporate officer) ~ ~ one. Map No.: .................... ~ ................. Lot No.~... 1. Location of land on which proposed work will be ~. ................ Street and Numbe~~li.4~.~l~.. ........ ~..~ll~ .................... 2. State existing use apd occupancy of premises and intended use and occupancy of prapaeed comtructlon: a. Existing use and occupancy ....... ~/~~ ............................................................................................... b. Intended use and occupan? ......~(,~.e~,*~ ......................................................................................... 3. Nature of wink (check which applicable): New Building ~....~......__ ..... Addition .................. Alteration ~ ........ ~'~??'~ Repair .................. Removal .... ::~ .......... Demolition ........ ~ ...... ;.._~Qt_ her Work. (Describe) .......................... ..~/~[ .... i. (to be paid on filing this applicatior~"'. ' 5. If dwelling, number of dwelling units ....................... Number of dwelling units on each floor ..,~i'. ..................... If garage, number of cars ..~ .................................................................................................................. 6. If busine-.s, 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 ..... ~..~. ........................ Rear ....~'..~. ................. Depth.'~..~... ................ Height ./....~..~. ......... Number of Stories ....~ ...................................................... ............................................. 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ i 1. Zone or use district, i~ which premises are situated ..... ,~..~. ................................................................................... 12. Does proposed const~ucfion~ rJ~'~ ,~ ~¥i91ate-any-z°ning law, ordinance or regulation? ..~. .................................................. 13. Name of Owner of premis~~'.~....Address ............................................ Phone No ..................... i~y PLOT DIAGRAM ~. Locate clear ' and distinctly all buildings, whether existing or prpposed, 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. STATE OF N~OlJJ~,,~ "ice ................................... ,~.~...~ ........ being duly sworn, d~o.~s ond sa¥~ thot he is the applicam (Name of in ~cli~dual 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 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. SwGal tczbefore me this ~-, . ~ ~ Notary Public~.-...~..~,,,F~.~....... County (Signature of applicant) NO. 52-8125850, Suffolk Cou~ Term Expires March 30, 1 AT' ~ 4O, .r