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Home My WebLink About6947-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING FER~IT CI'HIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FUf_L COMPLETION OF THE WORK AUTHORIZED) ~ z ~0,~...~.~".~ ....... .z...~..,,,7...~- Permission is hereby granted to: ~.~.~:.~, ...o...~..~ ~..r..7.~ ..Z~~.i~; ...... ~~.~.... ................. ...... ~Z2.~.~..~..c.~......-....~...:..~.:.... __-- ,o .................. ~.-.~../..~.c.~ ...... ~./..~..~ ..... ~ ..... ~2...e.a..~..4...~&~ ................. ~.~.....~../....z..../..~ ~-~'~-2~----~:::: ....................... ~ ........................................ ot,,e~i,,s,o~ote~ at ....... ~..~.ZJ....~...~..Z?......--... ..... ~..eZ.~..~..C.~..~....~.....~ pursuont to opplicotion Building Inspector. ~ee ,../..~......Z...~... FOI~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Permit No ................................... Disapproved a/c ..~,:.~.....~ .................................... APPLICATION FORql'I~'~G PERMIT INSTRUCTIONS a. Th~s application must be completely filled in by typewriter or in ink and submitted m triplicate to the Buildir inspector, w~th 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing Jocabon of lot and of buildings on prermses, relabonsh~p to adloming prermses or public streets areas, and g~wng a detaded descnpbon of layout of property must be drawn on the d~agram which ~s part of this applicatio c. The work covered by this apphcat,on may not be commenced before issuance of Building Permit. d Upon approval of th~s application, the Building Inspector w~ll ~ssue a Building Permit to the applicant Such perrr shall be kept on the premises available for inspection throughout the work. e. No budd,ng shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupan, shall have been granted by the Building Inspector. APPLICATION iS HEREBY MADE to the Building Department for the issuance of a Budding Permit pursuant to ti Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regutahons, for the construcbon of buddings, additions or alterahons, or for removal or demolition, os herein describe The applicant agrees to comply w~th all apphcable IQWS, ordinances, budding code, housing code, and regulations, and admit author,zed inspectors on premises and in buildings for necessary inspections. ............. ...... .............. a. ....................................... (Signature of apphc~nt, or name, if a corporation) ............ ............. .................... '/'"' State whether apphcant ~s owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or budd ................................ ; ................................. .......... ................................................................................. Name of owner of p emises ...........................-..~.....,.~.-~...r.:.3 ......... ~. ......................................................................... officer. Builder's License No ..................................................... Plumber's License No ............. ~...~..~...'.~.. ................... Electric,oh's L,cense No ..... /'~. Other Trade's License No ............................................... //~ X Location of land on which~roposed work will be d.~....e ~/,~.~Na ~.i~iiiiii ii'./~ot~ iiiiiil;iiiiiiiill Street and Number .... ..~...'~...~,...~....6..~.. ...... __...?.t( ...... Municipality State existing use and occupancy of premises and i~ended ~se and accupancy of p~posed construction: a ~-xisiting use aha occupancy ......................... ~...~. ......... ~ ....... ~..~....~..,,. ................ ~t....~ ........... : ..................... b. Intended use and occupancy ............................ ..~......~ ~ ~ ...................... ..~...~/! ~ ................................................. ~.~...~.~/~/-~....~."~ .~ .... Alteration . 3. Nature of ~rk (check which applicable). New Building .................. Addition .........74 Repair .................. Removal .................. Demolition ................. Other Work ...... ~..~../~V~.. ...................... (Description) 4. Estimated Cost ............................. ~ .............................. Fee ./.....~.. ........................................................... (to be paid on filing th~s apphcation) 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, spec,fy nature and extent of each type of use ...................... Dimensions of e~ist,ng structures, if any: Front ..........~..q. ............ Rear ........... .~...~. ............... Depth ./...~..~. ....... 7 Height ...... /...~" ............. Number of Stories ........... ~ ................................................................................. Dimensions of same structure with alterat~o~ps or additions. Front ............. ~...~. .................. Rear .. .?...~. .... Dept'h ........ /....~... ................ Height ......./ ..................; _ _Number of Stories ........................... ~ 8. Dimensions of entire new construction: Front ...~ ................... Rear ~ ............. Depth Height .................... Number of Stories ............................................................... 9 S,ze of lot Front ....... ...... ~ ....................................... Rear .,.....,,.r.:.. ........................... Depth--..~...,....-....,r..,.~..:.. , 10. Date of Purchase .........i k----~~...~.~....~.....~..~. ..................... Name of Former Owner ...~.** ' ..~.....O~....r~..~ ........ 1 1. Zone or use district in which premises are situated ...................................................................................... 12 Does proposed construchon violate any zoning law, ordinance or regulatzon ............................................... 13 Wtll lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises~....~ ........... ~,..~.~ ......................... Address ~/~,;~ ........... Phone N~..~...~....'~...~.~....~...~ Name of Architect ...... .~..~.....~ .............. Address ............................... Phone N~. Name of Contractor ...................................................... Address ................................ Phone No ...................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ex~sting or proposed, and red,cate all set-back d~mens=ons fro~ property hnes. G~ve street and block number or descriphon according to deed, and show street names and ind~cat whether interior or corner lot STATE OF NEW;~/,OJ~.,~. ~,-" ~,c c COUNTY O~F .~/~'~z4~...~-/~Z..._~.-.) TM ......................................................................................... bemg duty sworn, deposes and says that he ~s the apphca (Name of mdwidual s~gnlng contract) above named He ~s the ................................................................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and ~s duly authorized to perform or have performed the sa~d wo,~and to make and f this application; that all statements contained tha~ the work will be performed ,n the manner set forth m the application file~ ther. r.r.r.r.r.r.r.~.th/////' , Sw~ ~re me this ..... ..... Notary Pu bi ,c,c~Z.~. ~. :~4~ on, ,~t~ .............................