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Home My WebLink About5892-z FORM NO, 2 TOWN OF SOUTHOLD BUILDING DEPARTMEi4T TOWN CLERK'S OFFICE SOUTHOLD, N.. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 5892 Z Date ................... Permission is hereby granted to: pursuant to application dated ...........................~...~.~. .......... .~...~,....i... ~Building Inspector. Fee $...~.~,~0.: ........ at premises located at ......~,~...~.;L~1~/.,.l~a~ .......... : .................. ,!...,.; .................................................. i .................................................................. a~t~4 ......... .t~,,~,-...~ .................................................. 19..~..:.., end approved by the Approved ........................................ , FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT~ TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ; 19 ........ ,t No. ......... 19 ........ Pemif 1-/2 Application No, ,~-C ~ APPLICATION FOR BUILDING P~RMIT INSTRUCTIONS " t'~ a, This application must be completely filled in by typewriter or in ink and ~b~itted in triplicate to the Building inspector, wi 3 sets of plans, accurate plot plan to scale. Fee according to schedule. ; b. Plot plan showing location of lot and of buildings on premises, relationshii toiad oining premises or public streets or areas, anti giwng a detailed description of layout of property must be drawn on diagram whiih isl part of this application. c. The work covered by this application may not be commenced before issuance d f B~ilding Permit d. Upon approval of this application, the Building Inspector will issue a Buildin, i Per'nit to the applicant. Such permit shall be kept the premises available for inspection throughout the work. : nl e, No building shall be occupied or used in whole or in part for any purpose wl']tev~er until a Certificate of Occupancy shall have bee granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuanc~ ofia Building Permit pursuant to the Building Zon~,,~ Ordinance of the Town of Southold, SuffoUq County, New York and other applicable ~awi, Ordinances or Regulations, for the construct on buildings, additions or alterations, or for removal or demolition, as h~rein described. ~he iapplican'~ agrees to comply with all applicable lawsz~-~ ordinances, building code, housing code and regulations, and to admit authorized inspectors o~ premises and in buildings for necessary inspections2 {Signature of applicant, or name, if a corporationl {Address of applicantl ~al !ontractor, electrician, plumber or builder. State whether applicant is owner, lessee, agent~ a/:~hitec~t, engineer, §enoi Name of owner of premises .......... ~ .......... ~,~,-.i.: ................................................ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) ,~-~"~,~' '~ 1. Location of land on which proppspd work will be done. Map No.: ..,..~ ,%...! ..... Lot No ...... .../~.. .................................. [ Municipality a. Fxisting use and occupancy ............................... ~ .................... ....' '3. ' Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration....'......; ..... Repair ............. , ............ Removal ......................... Demolition ........................ Other Work ............... ~ ........... ~cription) 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 ......................................................................................... 9, Size of lot: Front ...................................... Rear .......................................... Depth .................................................. Height .................................................... Number of Stories ...................................................................................... 10. Date of Purchase ..................................... Name of Former Owne~r ............................................................................ 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 regraded ................................. W.i~ e~cess fill bej'emoved from pretenses: [ ] Yes [ ] No vllU (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 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, 1 COUNTY OF ,~ .............. ) o~ ~ ........................ ~/.......~~.'.~ .................. being duly sworn, deposes and says that he is the applicant above named. He is the ~.~ ................................................................................. ( Co~t~acfor, ~geat, 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 b~l~~ }la.ledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Hoiory public, St~t~ o~ New york ~, ~. Uo 52_0344963~[~oJk Cou~