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Home My WebLink About5852-z FOR~ NO, ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWH CLERK'S OFFICE SOUTHOLD, N!, Y. BUILDING PERMIT N? (THIS PERMIT MUST BE KEPT ON THE PREMISE~ UNTIL F~LL COMPLETION OF THE WORK AUTHORIZED) 585g Z ~ Date .................... .._...~..~.~ ........ .~. ............ 19....~... Permission is hereby granted to: ....... : ...................... ~.~,~...::~:....~;,.:::...~....:,.' at premises located at ............... ~..~,.~;~...~ pursuant to, application dated ...................· ........ ~ ....... ,x~-.~.., 19..~, ~ end approved ~y the Building Inspector. FORM NO. 1 TOWN OF SOUTHOLD ~ BUILDING DEPARTMEN~ TOWN CLERK'S OFFICE" SOUTHOLD, N. Y. Examined ........................................ , 19 ........ Application No ................................. Approved ........................................ , 19 ........ Pemif No ............................ · ......... Disapproved a/c ........... .~ ............................. ~ ........................ / .......... .4.~.. i cz' ....................................... /,....~ ...... ~. .................. Z...~ .................... (Building Inspector) APPLICATION FOR BUILDING P~RMIT ...... ..................... INSTRUCTIONS ~ a. This application must be completely filled in by typewriter pr in ink and ~ubn~itted in triplicate to the Building Inspector, with 3 sets of plans, accurate p~ot plan to s~a~e, Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationshi~ toladjoining premises or public streets or areas, and giving a detailed 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 B6ilding Permit. d, Upon approval of this application, the Building Inspector will issue a Buildin~ Pe(mit 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 wt~atev, er until a Certificate of Occupancy shall have been granted by the Buildmg Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuanc~ ofla Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable iLaw~, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described~ ,~he }applican~ agrees to comply with all applicable laws, ordinances, building code, housing code, and regu lotions, and to admit authorized inspectors oh premises and in buildings for necessary inspections. (Si~lnature of apphcant, or name, ~f a corporation) s of apphcant) ''~z~- //Y7) State whether applicant is owner, lessee, agent, architect, engineer, general Contractor, electri~an, plumber or builder. .................................................................................. ~.~ ............ JL...; ................................................................... Nam, of owner of premises ...... ~.~:~}~c~, ......... r~...~,~. ............ =........................................... ~ ~ ~ ~. If applicant is a corporate, signature of duly authorized officer. ; (Name and title of corporate officer) ~ ~. Cocation of land on whioh proposed work will be done. Ma~ ~o.: ...~J.~.~.... ko~ ~o....~'.~{: ........... 2. State existing use and occupancy of premises and intended use and occ~pa0cy of proposed construction: aEx st n use and occu anc ~-~,,~,~ ~s . ~;~ ~*t- ~ - ~v' -~-~ . p ............ .......................... ....... .......................... 3. Nature of work (check which lable): New Building ....................... ~tion ..................... Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work ~; .~,.~,;~.~,, ,~,...,,...,,.~,~,'~ ...... .~.~,~ ~ ./z ~i '- (D~l~criDtiol~ 4. Estimated Cost ......... ~.'.~.~., .......................... Fee ...... Z.~., .................................................................................... (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 ...............¢~%....q? ................................................ Dimensions of same structure with alterations or additions: Front .......................... Rear ......................................... Depth ............................................. Height ......................................... Number of Stories .......................... ~ ............. 8. Dimensions of entire new construction: Front ......'~'...~......~....~..... Rear ...~...~...5 ..~... ..... Depth ../.:..~..~....~....~-~ ../~..: ....... Height T..t¢~'....,~-~.~..== .................... ~qumber 04' Stories ........................................................................... . .............. 9. Sizeoflot: Front ................................... Rear....~...°...~....'/'.~ .Depth /..~.~...~..~.....~..~..~.. Height .................................................... Number of Stories ...................................................................................... 10. Date of Purchas ~..~../..~.~...%~. ....... Name of Former Own.e_r. .c~.~.~;.. .,. . ..-[.~fi... ........... 1 1. Zone or use district in which premises are situated ...~.. ......... ..z~...fT....~'../~.?~.~..~.~..,~. ............................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ............................................................ 13. Will lot be regraded ...... ..~.....O. ................ ~.. Will excess fill be remove~ from premises:f[--] Yes ~J No 14. Name of Owner of premises .~. ~~.~.~.....~...~...'~....~...~....~2.~..~..:.....'~..~.~.~...~..~....~...~.../~ .~..."~.. ~ ' ~ddress) (Pl~one No.) Name of Architect . . ~.'~..'..~. ....-; ............................................................................. . _ -. ~, (Address) ~ (Phone No.) Name of Contractor ......... ' ~' "~"';'"'"~ ...... ~""'" "~?'""~'~'"'~"~'~'~'~(Addressl 7 "' /'"";",rnone'"'"'""'t'Z~o.I ......... '~ 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 wheth- er interior or corner lot. STATE OF NEW.~OR~ ~_. ) COUNTY OF ....~>..%,~.~ ......................... ) SS .......... ~~.,,~~ ....................... being duly sworn, deposes and says that he is the app ,cant above named. (Name of iffdi~ual signing contract) ~ ,e ,s ,:he .................................. ........................................................................................................... , .................. (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 ~--(!g f .