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Home My WebLink About6053-z FOEM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N; Y. ,? .,! ~ '/ ,:! ; '~r/ Pe,rmissio~ is hereby //~, BUILDING PERMIT / (T~IS PERMIT MUST BE KEPT ON THE PREMISES C MPLETION OF THE WORK AUTHORIZED) Z granted to: UNTIL FULL /'~ .............. ~,.!-..,. i. :~: .?.,.',~.,,:~ ............. ~*;~ ~.tu,~ ....... ~ -, .~ ~ .............. i ................. .......................... : ........... ' pursuant'to applt~atlon dated ........................ A~ ......... ~ ......~ ....1~ ..... and apprgved by~ the FOKM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFIGE~ SOUTHOLD, N, Examined ................. ~.~, .................. , Approved ~ ~x 19..' ~ Pemit No. 0 Application No. ~ ''~-~ ~ ~ Disapproved o/c ........ ~~-'~'-C'ZL] ........................ (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and ~ubmitted in triplicate to the Building inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Pict plan showing location of tot and of buildings on premises, relationship to adjoining 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 Of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building 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 been granted by the Building inspector. APPLICATION IS HEREBY MADE to the Budding Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk 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, budding code, housing code, and regulations, and to admit authorized inspectors on premises and m buildings for necessary inspections. (Signature o~'applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .....;._/_..._.._... Name of owner of premises ........ .~ ...... ~ ..... ~ / If applicant is a corporate, signature of duly aut~7~rized officer. (Name and title of corporate ofhcer) 1, Locat on of land on which proposed work will be done. Map No.: .................................................... Lot No .............. Street and Number ................ ~,~,...--~.,..~/~....~.'~,.~...L%:~.. ...... ...~..~,'..5~?~' ................... I~,..,~,.~,~,,,Z.'.,~.,,.c~....(.;.,~,.~,.,~...Z/ , , MunicipaIffy 2, State existing use and occupancy of premises and intended use and occbpancy of proposed construction: a. Existing use and occupancy ................................. i ......................... : ........................................................................ Intended use and occupancy ................. ~.~..,~,~ ............................................................................ 3. Nature of work (check which applicable): New Building .......... ,~ ........ Addition ..................... Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... -~ O_~ I Description) 4. E-'stimated 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 ........................... ~.~.~ 2~... ;/~¢.. ~J ............ ........................................... 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 ........................................ ~....... Rear ........ .~..~.~ ...... ! Depth ....... ~.~..:.% ................ 8. Dimensions of entire ~ construction~ Front ............. ./ Height ..~.,/.~.~..~,~.~.~....~, umber of Stories ......................................................~ ..................... ~! ...... . l//,~/' Rear /~..~/~ ~/ Depth '..~....' j~//<2~ 7~J' 9. ~ize of lot: Front ...... ~...~...~.... ................. ........... .................. ^ ..... ..... ...... ..:~.. ....... , ............... 10. Date of Purchase ......... ~-~.//...?.2....~.... Name of Former Owner .:~/~.J~...~ ....... ./..~./J.~./.'./..%ff....~...~.../~..k~..'// 11. Zone or use district in which premises are situated ............................... ..ZT(~...~;~.J./...~..L....c~....¢~.L.~, ............................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................ g~'..~ ..................................... 13. Will lot be regraded ......................... ~ ...... Will excess fill be removed from premises: [ ] Yes [~ No ~lame of Owner of Drem scs ........ ,~.~./.~.¥~J, JJS,..%,......~2--......~....~.....f~..'.~.~././...~.~ ...................... .2~..~.'.~...-.~.'.~../..?.. ..... 14. - -- / (Address) (Phone No.) Name of Architect ......................... ~... ................................................................................................... ~ ~.~ / / ~/ (Address) /C")- ]. (F~oneNo.) Name of Contractor ...~.~.~.)~2~.....~.~J~.~./.~..,C~...0../...v)...~.../.LY...~ ...... Z.I.J..~.~.....~..~...¢~.~;~.~.~;~i ............... (Address) PLOT DIAGRAM I.ocate 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. I STATE OF NEW YOR~',, ,~//y) /~ COUNTY OF .......... ~~.~ .......... ) ................................... ~~,,...~.,,..~~uly' sworn, deposes and says that he is the applicant above named, .e ,, ............. .................................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to ~rform 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 set forth in the application filed therewith. ................................. o, .............. ...................................................................... .... .................................................................. ~ ~[Si~amre ofappNcant}