The URL can be used to link to this page

Home My WebLink About6258-z FORM NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENt TOWN CLERK'S OFFICIO' SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON TI~E'~REMI~ES UNTIL FULL COMpLEyJoN OF THE WORK AUT/~OP~IZED) N? 6258 ~:_;.Z _: ~ote ..... Pe~rmission is hereby granted tc~ / · · J/ ' premises Iocoted ~t ........................... ~. .................................. : ........ : ...... · ................................... pursuant to application dated .~/~.....~, 1~'7~, and approved by the / Building Inspector. Fee $..../.,~.....~. FORM NO. 1 [ ~z>, :~, ~ TOWN OF SOUTHOLD ~-~-~ ~" BUILDING DEPART~EN~t*~/%[~/*z-. F'~ c~fv~v~ ~ ~ TOWN CLERK'S OFFICE~. /~.~,~ ~,,.~,~. >~>~__~ ~ SOUTHOLD, N.Y. ///~/~ ~ ~is*pproved ~/c ............................................................................... ...~ ...... .............................................................. ..... (Build~fl Ihspector) APPLICATIOg FOR BUILDING P~RMIT ~ I ~STRDCTIO~S ~ a. This application must be completelg filled in b~ Wpewriter or in ink and submitted m triolicate to the Buildm~ Inspector~ with 3 sots of plans, accurate plot ~lan to scale, floe accordin~ to schedule. ~ b. Plot plan sho~in~ ~ocation of [ot and o~ Buildings on premises, relationship to ad~oinin~ premises or public s~reets or areas, and~ ~iuin~ a detailed description of legout of pro~erW must Be drawn on diagram which is part of lhis application. c. The work covered bg tMs application may not be commenced before ~ssuance ~f Buildin~ Permit. d. Upon approval of this aOOlication, the Buildin~ Inspector will issue a Buildin~ ~ermit to the apohcant. Such permit shall ~e kept on the oromises aua[lable for inspection throuohout the work. e. No bui~dinB shall ~ occugied or used in whole or in part for any purpose whatever Bnti[ a certificate of Occupancy shah have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuanc~ of a Building Permit pursuant to the Building Zone Ordinanoe of the Town of Southo~d, Su(fo~k~ 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, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corp'6ration) (A~l'~l'ress of a pplica nti ........... ~) ~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................................................. ..................... : .......................... Name of owner of premises ..... ~..~,.'~..~..J~... '~- If applicant is a corporate, signature of duly authorized officer. ..................... ..................... 1. Location of land on which proposed work will be done. Map No ....... Cq~ ...... Lot No ...... ~] .................................... Street and Number .............. ~ ~ ..... ~.:-.-..b., .................... ~ .............. -- Municipadty 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ......... ~..~.....~.'..'~.. ............ ~...~......-(...~.. .................................................................... occupancy ............. ~ ....................................................................................................... b. intended use and Nature of work (check which applicable): New Building ...... ~ .......... Addition ......... ~,~... Repair .......... ~ ....... Re~oval .......... ~ ........ .~gemo~tion ....... ~ ........ Other Work~...~ 4. Estimated Cost ~D '~ . , oo .............................................. 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, spec~ure and extent of each type of use ..... 7. Dimensions of existing structures, if any: Front .._'['~¢~ Rear ....~1~ .................... De Height .................................. ~'~ .................. Number of Stories ...... ~ Dimensions of same structure with alterations or additions: Front .............. .~. ...... Rear ........ Depth ,~ ........ Height .......... ~ ........................ Number of 8. Dimensions of entire new construction: Front .......... ~.. Rear .............. ~epth Height ........................ ~ ............ Number of Stories ............. ~ ................................... 9. Size of lot: Front .......... '.\V.[c).~.~. ........... Rear ........ Height .................................... ~ ......... Number of Stories ................ ~ .............................. 10. Date of Purchase ....~..~v....'~,..~....~,..~..~./.... Name of Former Owner ...1.~..[~.)~.~ ......... ..~....~.Y~l. 11. Zone or use distr ct in wh ch premises are situated ........... ,~"~ .... 12. Does proposed construction violate any zoning law, ordinance or regulation: ....... ~,.. ........... 13. Will lot be regraded ................ ~:~. ........ Will exc~.ss fill be removed from premises: [ ] 14. Name o~ ~(~w~ner of pr~r~s~es .~)...,~ ....... .~..[ ...... . .~..~. ....... ~...~.)~...:~..~...~..:.~..~].1.~ (Address) Name of Architect ~ (Address) Name of Contractor ........................... ~ (Address) ~,lteratio~ .... (Descript No.) No.) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, property lines. Give street and block number or description according to deed, and show street er interior or corner lot. )ck dimen ;ions from and indic Itc wheth- applicant. )eve named. etlon; that air the mannem STATE OF NEW YORK, ) SS COUNTY OF ...................................................... ) .......................................................................................................... being duly sworn, deposes and says that he is t~ (Name of individual signing contract) 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 fiI this appli( ;tatements contained in this application are true to the best of his knowledge and belief; and that the work will aerformed s~ forth in the application filed therew;th.