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Home My WebLink About6868-zApproved ................. ~.: ..... i~. ............. , FOB, M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 19..7~.. Permit No ...... ..~,...,~...i..~.,...~,.~... Application No ................................ D~sopproved a/c ....... ~,..~ ' Date .................. .............. INSTRUCTIONS o. Th~s application must be completely filled ~n by typewriter or in ink and submitted m triplicate to the Buildin Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing iocahon of lot and of buddings on premises, rebbonship to adjoining premises or pubhc streets c areas, and giving a detaded descriphon of layout ofproperty must be drawn on the d~agram which ~s part of th~s applicatior c. The work covered by this apphcation may not be commenced before issuance of Budding Permit. d Upon approval of this apphcation, the Budding Inspector wdl ~ssue a Budding Permit to the applicant Such perm shall be kept on the premises available for inspection throughout the work. e. No budding shall be occupied or used in whole or in part for any purpose whatever unbl a Certificate of Occupanc shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances, Regulabons, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe, The apphcant agrees to comply w~th all apphcable laws, ordinances, building code, housing code, and regulations, and i admit authorized inspectors on premises and in buildings for necessary inspections. ..... ...... (Signature of applicant, or name,, i~f a co/porg.~n) ~- (Address of applicant) State whe~ther apphcq~t ~s owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde ....... · ....... ........ .......... ; .................................................................... Name St'owner of premises ....//~.~¢¢~,~../~.,,......~.1¢'~¢~...~.?~.....~ ....... : ....................................................... If apphc//q~t is.~orate, Si~lnature of duly authorized off,cer. · ......... Budder's License No .................................................... Plumber's bcense No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... Location of land on whi~rop_osed~./~, -- --w°¢( will~ ,, ~-.~b~d°.~//~Aa~ ...................................... Lot No Street and Number ..~.~'¢~r~...'~...~/~..:..~~( Municipality State ex~stmg use and occupancy of p~emises and inte~Jed use and occupancy of proposed construction: bi Intended use and occupancy ]i...~~~i]iii~~~ilY~....~...i.].]] .]] i ]]]]]]iii]]]] '3. Nature of work (check which apphcable)' New Budding .................. Addition ....... --'--']~."'z;~' ·. ~,,,,--~AIteratian~. ..... Repair .................. Removal .................. Demolmon ................... Other Work ...... .¢¢~F. ~.~. · .'~¢.: :.:~. · ;! ........... ..--- . .~' . (~e~,ption) ,. .................... ......................... ............................ (to be paid an filing this application) · 5. If dwelling, number of dwelling units ........................... Number of dwelhng umts on each floor ....................... If garage, number of cars ........................................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type af use ....................... 7. Dimensions of ex~sting structures, if any: Front .......................... Rear ................................ Depth .................. Height ........................ Number of Stories .............................................................................................. Dimensions of same structure with alterations or additions: Front .................................. Rear ........... Deplh ................................Height ...........................Number of Stories ................................ 8 Dimensions of entire new construction: Front .................................Rear ........................... Depth ...... Height .................... Number af Stories ....................................................................... 9. S~ze of lot Front ........................................................ Rear .......................................... Depth ........................ ]0. Date af Purchase ................................................ Name of Former Owner ............................................... 1 I Zone or use &strict in which premises are s~tuated ....................................................................................... 12 Does proposed construction violate any zoning law, ordinance or regulation 13 Wdl lot be regraded ........................... Will excess fill be removed from premises: ( ) Yes ( ) No 14 Name of Owner of premises ................................................... Address ................................ Phone No ...................... Name of Architect ...................................................... Address ................................ Phone No ...................... Name of Contractor ........................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and d~stmctly all buildings, whether ex~sting or proposed, and red,cate all set-back dimensions fron property hnes. Gwe street and block number or description according to deed, and show street names and ind*catc whether interior or corner lot -- j/////// /v"/4 s'r^T OF COUNTY O F~rx4~'~Z'' (Name of indlwdual s~gning contract) duly sworn, deposes and says that he ~s the apphcam above named He ~s the ..................................................................................................................................................................... (Contractor, agent, corporate officer, etc ) of said owner ar owners, and ~s duly authorized to perform or have performed the sa~d work and to make and file this opphcatlon; that all statements contained ~n this apphcation are true to the best of h~s kn~g.~wledge and behef, ant that the work will be performed m the manner set forth m the application filed therewi~Jg ~ /t Sworn to befard me this / . . _ .~.~// / 1/ / ........... /z....= ..... C - ¥ Ss 7