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Home My WebLink About6984-z I~ORI~ NO. :~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING P. ERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6984 Z Permission is hereby granted to:x Building Inspector. Examined Approved FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFIGE SOUTHOLD, N. Y. 19/~.... Permit No .... . .~...~...,~..~.,..~........~...... APPLICATION FOR BUILDING PERMIT Date ........... L.I../.(.~'.f./ 2....~... ........... ,19 ........... INSTRUCTIONS a. This apphcat,on must be completely filled m by typewriter or' m ~nk and submitted in triplicate to the Buildin., Inspector, w~th 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b Plot plan ~howing Iocahon of lot and of buildings on premises, relationship to adloimng premises or public streets o areas, and giving a detaded description of layout of property must be drawn on the d,agram which ~s port of this application c. The work covered by th~s application may not be commenced before ~ssuance of Building Permit. d Upon approval of th~s application, the Budding Inspector will issue a Building Permit to the apphcant Such permi shall be kept on the premmes available for inspection throughout the work. e. No building shall be occupied or used m whole or in part for any purpose whatever until a Certificate of Occupanc: shall have been granted by the Budding Inspector. APPLICATION IS HEREBY MADE to the Budding Department for the ~ssuance of a Building Permit pursuant to th, Bu~tdmg Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described The applicant agrees to comply with all apphcable laws, ordinances, building code, housing code, and regulations, and t, admit authorized inspectors on premises and in buildings for necessary inspe~t,'(6~ (Signature dF apDlicant, or name, if o corporation) State whether apphcant ~s owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or budder Name of owner of prem,ses ....--',~..~'.~.{~]t.J~.....~.x..~.'~c.~.~,.L ..................................................................................... If applicant is a corporate, s~gnature of duly authorized officer. (Name and title of corporate officer) Builder's License No. ~ Plumber's L~cense No ................................................ Electrician's License No ............................................. Other Trade's License No ....... ...... :.'::, .............................. · '~--/~...~. Z...~...~... Location of land on whic~h propose~d w_9_ork~jll..~be done Map No ...... ~ ............ Lot No ......... Street ond Number ~.~.~. ,~2 .~-,~..~ .~,~.~.. ................ Stale existing use and occupancy of premises and intended use and occupancy of proposed construction' a F. xisiting use and occupancy b. Intended use and occupancy .......... ~,:(~,'.~. i ...... ,,~':z. ~. ...... ~.....~,~/~.~. ..................................... Nature of work (check h applicable). Repair .................. Removal'~.,.Ij ............... Estimated COst ...................... .j~ .................. lew Buildin,g. ....... ~ .......... Addition .................. Alteration ........ : _ ~emol ,t ~ .,arf/......~ .......... (Dther Work ................................ /// / (Description) ...~" ........ Feel ........................................................................ ~ (to be pa~d on filing this apphcotion) If dwelling, number of dwell~g units ..........................N~mber of dwelling umts 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, Jf any: Front ............................ Rear ................................ Depth ................... Height ....................... Number of Stories ............................................................................................... D~mens~ons 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 S~ze of lot' Front ................................................ Rear ........... ~ ............... Depth .................... 10 Date of Purchase ............ ~ .................................... Name of Former Owner ......................................... 11. Zone or use district m which premises are s~tuated .............................................................................. 12 Does proposed construction wolote any zoning law, ordinance or regulation ................ 13 Will lot be regraded ............................ WHI excess fill be removed from premises: ( ) Yes ( ) No t4. Name of Owner of premises ................................................... Address ................................ Phone No ....................... /j' Name of Architect ............................................. Address ................................ Phone No ....................... Name of Contractor .................................. Address ................................ Phone No ...................... PLOT DIAGRAM Locate clearly and d~st~nctly all buildings, whether exist~ng or proposed, and red,cate all set-back dimensions from property hnes. G~ve street and block number or description according to deed, and show street name~ and ~nd~cate whether interior or corner lot STATE OF NEW YORK, ~ c c COUNTY OF ............................... J'~'~ .............................................................................................. being duly sworn, deposes and says that he ~s the apphca.m (Name of ~ndividual signing contract~ above named. He ~s the ................................................................................................................................................................. (Contractor, agent, corporate officer, etc ) of sa~d owner or owners, and ~s duly authorized ta perform or have performed the sa~d work and to make and f~lc this apphcation; that all statements contained ~n th~s applicat,on are true to the best of his knowledge and belief, ant that the work will be performed in the manner set forth ~n the apphcation filed therewith. Sworn to before me th~s ........................ day of .................................. '. ..... , 19 ...... Notary Public, . ............................................... '...: County ....................... ~ ....... : ...... ~.~ .................................... ~ (Signature of apphcant)