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HomeMy WebLinkAbout5805-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK's OFFICE ,SOUTHOLD, N,. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) so. z Permission is I~ereby granted to: - ~ ~ ....... and approved by the: pursuont t~ oppli¢otion doted .. ..................... .~.~.-!~ ..., .19_ ., Building, Inspector. ,' Fee $...~"~' ' ......... ! ' ~ Bdildi~g ~spect~lr Approved ........................................ , FOI~M NO. 1 TOWN OF SOUTHO~D ~ BUILDING DEPARTMEN'' TOWN CLERK'S OFFIC~ SOUTHOLD, N. Y. 19 ........ m' rqo ..................................... Application No.......~..~...o..~..-]. .............. Disapproved a/c ............................................................................................ APPLICATION FOR BUILDING ~ER~IT ale .a 'r.j.1 12 19~ ........ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and ~ubm~itted in triplicate to the Building Inspeetor with~ 3 sets of plans accurate plot plan to scale. Fee according to schedule. ' b. Pict plan showing ~ocation of lot and of buildings on premises, relationshi~ to! adjoinir~g premises or public streets or areas, and giving a detailed description of layout of property must be drawn on diagram which i~ part of this application. c. The work covered by this application may not be commenced before issuance bf Bbilding Permit. d. Upon approval of this application the Building Inspector will issue a Bu Id n~ Perm t to the app cant Such permit shall be kept on~ the premises available for inspection throughout the work. i e. No building shall be occupied or used in whole or in part for any purpose wi~ate~er until a Certificate of Occupancy shal 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, Suffo[l~ County, New York, and other applicablelLa~, Ordinances or Regulations, for the construction of buildings, additions or alterations or for removal or demolition as herein ~eser:ib~d. ~hei~pp cah~ agrees to comp y w th a app cab eaws ordinances, building code, housing code, and regulations, and to admit authorized inspect?rs o~ premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) (Address of applicant) State wheiher applicant is owner, lessee, agent, architect, engineer, gene)'al ~ontractor, electrician, plumber or builder. 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.: .~(~;,.. '""i'"" Lot No ........ ~x ................................. Street and Number .......... ~. .............. ~.~,...:; ................... ,~ ......... ,0. .......... ,,..,..:. ................................................................ !~ Municipality 2. State existing use and occupancy of premises and intended use and occd~ad, cy of proposed construction: a. Existing use and occupancy .......... .~,,,~.].....Ltq_(; ............................... ,...,..~, ................................................................ 3. Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration...~ ........... Repair ......................... Removal ......................... Demolition ........................ Other Work ....... ~.~.r~.~.....~ ............ (Description) 4. Estimated Cost ............................................... Fee .....!.~.:..0,.0,. .................................................................... : ........... (to be paid on filing this application) 5. If dwelling, number of dwelling units ..~i~e ...... 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 ......................... L ........... 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 .................... l ............ Height ................................................. Number of Stories ......................................................................................... 9. Size of lot:' Front .......... .~ ....................... Rear .......... ~.Q ........................... Depth .....1..0~). ...................................... Height .................................................... Number of Stories ...................................................................................... 10, Date of Purchase ..................................... Name of Former Owner ............................................................................ 11. Zone or use district in which premises are situated ........ ~l.~..t.~....~;~..~.~ ............................................................ ~ ............. 12, Does proposed construction violate any zoning law, ordinance or regulation: ............ ~ ........................................... 13. Will lot be regraded ..... .n...o. ........................ Will excess fill be removed from premises: [ ] Yes [ ]:XNo 14. Name of Owner of premises ....});.f~lg.e..3...J~.J.r~;~.L~;f~zl ................................................................................. ~ ............. ' (Address) (Phone No.) Name of Architect ..................................................................................................................................................... (Address) (Phone No.) Name of Contractor .......... .S.~,r~l~. ................................................................................................................................ (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 v ,herb- er interior or corner lot. STATI: OF NEW YORK, ) COUNTY OF ............. o.~.;[..o.].~ ..................... ) 2~]. ~)~_12g~©12 being duly sworn, deposes and says that he is the applicant above named. (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 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 il~ the manner set forth in the application filed therewith. ~LIZABETH AN~ NEVIL~_'E '~0TARY pUt~LIG, State of New ¥or~ I ~ ...... No, 52-8125850, Suff01k Cou,~t~ .............................. .~.....,.day of .......................... ~p:l?.:I~,, ......... 10 ..'~d, ...... Term Expires M~(~%30, )9,7~L- , Notary Public ount ................ I ..................... O / /] t,~ ' ($ignat~re,-oJ~ppttcant)