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Home My WebLink About6143-z FOF. M NO. ~ TO~N OF $OUTHOLI~ BUILDING DEPARTME~IT TOV~'H CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMI~ES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) , BuilO~ng Inspector FOI~M NO. 1 TOWN OF SOUTNOI~D BUILDING DEFARTMI!NT TOWN CLERK'S OFFICE SOUTHOLD, N. Exomined ........................................ ,?, Z..2~...~.. 19 ........ ^pproved ................... ...... ,1.7....'C... pem,f No. .......... Disapproved a/c ..................................................................................... ....... ng mspecr( APPLICATION FOR BUILDING PERMIT · Dote.. ................... , INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink an(] submitted in triplicate to the Building Inspector, with 3 sets of p~ans, accurate plot plan to scale. Fee according to schedule. b. Pict p[en showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of [ayoul~ of property must be drawn on diagram which is part of this apphcatiom c. The work covered by this application may not be commenced before issuanc~ of Budding 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 work. ~ e. No building sha~l be occupied or used in whole or in part for any purpose Whatever until e Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuar~¢e of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffot~ County, New York, and other applieablb 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, housm§ code, and regulations, and to admit authorized inspedtors on premises and in buildings for necessary inspections. (Signature of app'l~?~t, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. '"'"'"'"""'"'"'""'"'"'""~a eofo Der of e ....... "'" ...... '"'"'" .... i~ m w pr m ses .............................. ~.~,-~.~ .................................................................................................. If applicant ~s a corporate, s~gnature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on whicC~4~roposed work will be done· Map No.: ......... ; .......... Lot ~,~....:..., .................. .~ ................ Streetand Number .'. 't /[~-~..~. I ,.~.b~ ~ 6 ~ ~W~Z~ -~ ............................. r ...................... ........................................ '~i~'(~~ ...... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ............... ,~-~[~4_- .~-~-~-~..~- ...... [~~ ........................................................ b. Intended use and occupancy ~ Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration ....... Repair Removal Demolition ........................ Other .................................................. ( Description)- 4. Estimated Cost ............ /...~,,, .......................... Fee ............... L.~..~.. ................................................................ · (to be paid on filing this application) 5. If dwelling, number of dwelling units .................Number of dwelling units on each floor ....................................... If garage, nu mber 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 ......................... Rear ............................ Depth ............................... / Height ................................................. Number of Stories ........................................................................................ 9. Size of lot: Front .........~..9..f .................... Rear ......... ~.,2 .......................... Depth Height...... ..... .. ,....,....,........,,,, _ ,. Number of Stories ...................................................................................... 10. [)ate of Purchase ..................................... Name of Former Owner .......................................................................... 1 1. Zone or use district in which premises are situated ............................................................................................. 12. [)Des proposed construction violate any zoning law, ordinance or regulation: ...... ~,~..¢ ............................................ 13. Will lot be regraded ..................................... Will excess fill be removed from premises: [ ] Yes [ ] No 14. Name of Owner of premises ...................................................................................... ..................................... (Address) (Phone No.) 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 dimensi property lines. Give street and block number or description according to deed, and show street names and indica' er interior or corner lot. I ! sworn, deposes and says that he is the applicant STA-rE OF NEW~ORK~ ~ , . . COUNTY OF ...... · .'~. ,%~ · · .~T..~ .~;-'~'~ ,~/~',~ ................... ) S~' ........ .,..~,.....~'% ..~...~:;~.-~t~ ,.........~., .~..~'....¢3..~ ........................ being duly ' (Name of~dividual signing contr ct) He is the ..................................... .1~_..~_...~..0~,. ............................................................................................................................ (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 appli :;tatements contained in this application are true to the best of his knowledc, le ,and belief; and that the work will be performed set forth it, the app[ication filed therewith, ?U[;L~,Ls~t~te~0f~ New York ~ "~ARY P o, 52-61682-J .......... ........ _.dayo, ........ \ %. . ~("%. · w, ........... [ - ' ' Notary Pub,Jo, .,..~..~~... County .............. ~'"'~i ............. (,~igna[ure o,t~pttcant / ms from ~heth- ~tion; that aI in the mann~