The URL can be used to link to this page

Home My WebLink About5745-zTOWN OF SOUTNOLD BUILDING DEPARTMENT TOWN C~RK'S OFFI~ SOUTHOLD, N. Y. Application No ................................. Examined /~ ~)]~ 7'~ Approved .................... /.~........~.....~, 19......~.. e-~S~mJt No. Disapproved a/c ..... ...'~...........~ ................. ~ ....................... ................................................ iiiiiii ii ZZ ........................ (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ...~..//.~.~....../..~ ................ , 19...~.~,. INSTRUCTIONS a. This &pplication must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with-~ 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, relationship to adjoining premises or public streets or a~eas, and giving a detailed description of layout of property must be d~wn on diagram which is pek of this applicetion. 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 shell be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in pert for any Purpose whatever until a Certificate of Occupeney shall have been~,~ granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of e Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffotk County, New York, and other applicable laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demofition, as herein described. The applicant agrees to comply with all applicable ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necemry inspections. (~lnature of applicantJtbr name, if e corporation) (Address of applicant) State whether applicant is owner, lessee, agent, amhitect, engineer, general contractor, electrician, plumber or builder. ....................................................................................................................................................................... Name of owper of premises .... .~.O,Z~._q.....~.....~-(~.O..~..;3~ ...... /~1/~/.~.......(4A,~.~'/~_ ............................................. If applicant i~,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.: .................... Lot No...., ................... .....,~.~ ............ Street ~ Number ....J~:U./~.R.~,~ ...... l~)O~,.~ ......i~'~'~.~., .......... i ....................... '....~.J~.~,~.....:..~...~.~.:....~.l,~;'it '~ .... ~ ~ ~ ~7 , 2. State existing um and occupancy of premises and intended use and occupancy of proposed construction: / FA/v///_ a. Exilting u~e and occupancy .............;.. ..................................................................................................................... b. Intended use and occupancy ........................................................ .,~.~ 3. Nature of work (check which applicable): New Building ...... ~ .........Addition ..................... Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work (D~scription) zo..o. I 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 eddifion~ Front .......... ~ .............. Rear ................................ :,~ ...... Depth ............................................. Height ......................................... Number of Stories ............................... ~; ....... ! 8. Dimensions of entire new construction: Front .......... ./~. ......... Rear ......... ~..0.. ............ Depth ....... ~..~..../. ................. · Height Number of Stories ./.. ............. 9. Size of lot: Front ............... · ....................... Rear .......................................... Depth .................................................. Height ......................................... ; .......... Number of Stories ...................................................................................... 10. Date of Purchase ..................................... Name of Former Owner ............................................................................ _ 11. Zone or use district in which premises are situated ....~..(~,S./..~.~.Z2./..,~.~--~.. ......................................... - ............... 12. Does construction violate zoning law, ordinance or regulation: ...x~.~. proposed any 13. Will lot be regraded ....... ../~.~ ................... Will excess f. iil be removed from p??~sesL[ ] Yes ,,m of Owoorof prem,. ..... ....... ........... IAddre~) {~honc No.) Name of Arehi~t ..................................................................................................................................................... {~ddrassi i~hona No.) Name of Contr~tor ................................................................................................................................................... {Adding) |~ho~a No.) PLOT DIAG RAM ~L...o..cate clearlyand dis~in~tly'all I~u,~ldings, whether existing or proposed, and indicate all set-back dimensions from / property I.hes. Give street and bfocl~ nu'm~er or description according to deed, and show street names and indicate whath-/ er interior or corner lot. STATE OF NEW~, I ~S COUNTY OF ................................ .............. ..~....P~. .......... ,,.~...~..~...~.;..~. ............. ,.~...~ ~,....~.. ..............~ing duly s~rn. ~s and .ys th~ he ,, ~e ,~,i~, ,~. n~d. '(~ o[ ~ s~ ~n~cO Heis~ ~O -- O~ .......................................................................................................................................... (~n~tor, ~nh co~ o~, e~.) ~ of ~ ~r or o~, and is duly ;u~iz~ to ~orm or ~ ~d~ t~ ~id work a~ ~ make a~ fi~ ~is ~li~t~; ~ aH ~ ~tain~ in this a~i~ am ~ to t~ ~ of his knowled~ and ~lief;a~ t~t t~ ~ ~ll ~ ~ in ~ ~mr ;U~8~H ~ ~1~ o, ........................................ ,0. TOWN OF $OUTI. I~I~D BUILDING D~pART~'EN~ TOWN CLERK'S SOUTHOLD, N, Y.' BUILDING PERMIT , (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL ~ULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: pursuan¢ to application dated ............ t ,~ it~ '~]~.7.~',--7"1:~1 approved by the Building Inspector. Building Inspector