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Home My WebLink About6155-zTO~N OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREM SEg UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: .................... ~.~ ............ ~..~.~ ........ . Fo..~.......c,.~.~,. ...... ~z._7~.~.~.~ ........ ,~..'~o~...~..~..**~.~ .~, ..... '~'"'~'~'"'~'""~'~~": ................................. ~' .......... i ...................... /' ..................... ot p,em,se~ '~o,ed ~..~¢-..~ ....... ~...~..-7~.~':.~'""~" pursuant to application dated ................................................... i*..,., 19 ........ , and approved by the Building Inspector. ~/ v :- ~ Bu~ldmg~Tnspec~r-- -( Examined ....... .d.../. ........................ Approved .............. FORM NO. 1 TOWN OF SOUTHOLD : BUILDING DEPARTMEN~ TOWN CLERK'S OFFICEr. SOUTHOLD, N. Y. Disapproved o/c ......................................................................................... ~.. ................... nape t J;'i ................................ APPLICATION FOR BUILDING PERMIT Dote ........... .F. ~.~.. ~-.~. ........................ , 19..~...~.:.._ INSTRUCTIONS hl a, This apphcation must be completely filled in by typewriter or in ink and submitted m triplicate to the Building Inspector, wit 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Pict plan showing location of lot and of buddings on premises, relationsh~ to adjoining premises or pubhc streets or areas, and~ giving a detaded description of layout of property must be drawn on diagram which is part of.this application. c. The work covered by this application may not be commenced before issuance 6f Building Permit. d. Upon approval of this application, the Building Inspector will issue a Buildin~l Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout 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 beer~ granted by the Building Inspector, APPLICATION IS HEREBY MADE to the Bugdmg [3epartment for the iesuande of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable iLaws, Ordinances or Regulations, for the construction of buildings, additions or alterauons, or for removal or demolition, as herren described. ~l-he applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature Of apphcant, or nam~f a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, gene'rai contractor, electrician, plumber or builder. ................................... (.~-;C/.~.. ~.~.~ ................................................................ ; ......................................................................... Name of owner of premises ........ :,Z/.~.?.~,/.L~/...../~.,.....~,:~;.~.~...~..~¥. ................... ; ......................................................................... 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. Map No.: .............. './~.~..::.......~.../. .................. Lot No..:.~,.~ ..... Street and Number ....... /..~..~2...../~./~.~./).2~ ....... ~.~4~Z[/...,~.~. .............. i,, ...................................... ./m..~.._/~,/,~,~.~ .......... Municipality 2. State existing use and occupancy of premises and intended use and occapancy of proposed construction: a. Existing use and occupancy ....../.~'.47d~2~7-' .................................................................................................................. b. Intended use and occupa,ncy ~,,"'.~.~/M~'~-~..r:..~/~,,/.~.~/.~/~.-.(.~/.,'~.t~.,;~... :~.~.-,.. ,~.~-~,,,z~=/_~,,,.//,~;~.~ ...................................... .~ 3. Nature of work (check which applicable): New Building ....................... Addition ..................... AIterati~)n .............. Repair .... ~, Remora ............ Demolition ....... Other Work .........'~-,./~.~2.~.~: ......... ................ ~.>~' " - ~ ( Descriptior 4. Estimated Cost ........~..~,..~ .................... 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 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 ........................................................................................ ,-' . ' ' ' Depth .~.~.2,,...~.~ ............... 9. o~ze of lot: Front .....~z.~ .................. Rear .................................................. 10. Date of Purchase .. ~. .~.~.~=..... Name of Former Owner ........ ~ ............. 11. Zone or use district in which premises are situated ..... ~;(.~.;~'~ ....................................... .~ .............. 12. Does proposed construction violate any zoning law, ordinance or regulation: ....... ~. ............................................. 13. Will lot be re~aded .......... ~ ................. 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 .................................................................... ~.~) ............................................................... (Phone No.) PLOT DIAGRAM Eocate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensi from property lines. Give street and block number or description according to deed, and show street names and indica wheth- er interior or corner lot, _~D~Z~-~/~ ~'~ ~ ~' ~1~ COUNTY OF~~~ .................... ) .......................................................................................................... being duly sworn, deposes and says that he is the applicant ab ve named, He is the ................................................................................................................................................................................................................ (Contractor, ~e.t, corporate of~eer, etc.) of sa d owner or owners, and s du V author zed to ~rfor~o.[ have performed the said work and to make and file this applicalion; that all statements contained in this application are true to t~e~est,,e~,,h~s;k, nb~lddge and belief, and that the work will be performed in the manner set for :h in the app cation f led therew th ................ ~..~......dav of ................... ............... ............... ................. J .................. ~ '