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HomeMy WebLinkAbout6513-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~. Y. BUILDING PERMIT ~1'HIS PERMIT MUST BE KEPT ON THE P]~EMISES UNTIL FULL COMPLETION OF THI~ WORK AUTHORIZED) N? ~s z Dote .......... ~ ....... ..%....~ ..... to~( Permission is hereby granted \~ . ,o .... pursuant to applica~:ion dated ....................~:..~....~... .......... , 19.,?.~..., and opproved by the Building Inspector. Fee $..~.~.~.~..~: ...... .......................... ~/~ii~;~'~"T~' ..... TOWN OF SOUTHOLD r'~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ....I~J A ~..--. . .':~...~ ."Z.........5 .......... Approved .............. ........ ;.,r. ........... , Disapproved a/c ....... ~ ..................... , ....... ~'"'i~ .... APPLICATION FOR BUILDING PERMIT .........., ote ...................................... INSTRUCTIONS a This application must be completely fdled in by typewriter or in ink and submitted in triplicate to the Building Inspector, ~ 3 sets of plans, accurate plot plan to scale. Fee according to schedule b. Pict plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, giving a detailed description of layout of property must be drawn on diagram which ~s part of this apphcatlon. c, The work covered by this apphcatlon may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will ~ssue a Building Permit to the applicant Such permit ,shall be kept the premises avadable for inspection throughout the work. e. No building shall be occupied or used in whole or ~n part for any purpose whatever until a Certificate of Occupancy shall have I granted by the Building Inspector APPLICATION IS HEREBY MADE to the Building Department for the ~ssuance of a Building Permit pursuant to the Budding Z Ordinance of the Town of Southold, Suffotk County, New York, and other applicable Laws, Ordinances or Regulations, for the constructlr buildings, additions or alterations, or for removal or demolition, as herein described The applicant agrees to comply with all applicable h ordinances, budding code, housing code, and regulations, and to admit authorized inspectors on premises and ~n buddings for necessary mspectl, (SlgnatUre-6L, alSphc)~,, c~r Dame, Ifa corporation) ........ (Address of apphcant) State whether npplicnnt is owner, lessee, agent, architect, engineer, general aontrnctor, electriainn, plumber or bull, If npplicnnt is n corpornte, signature of duly authorized officer. IName and title of corporate officer) Builder's L~cense No .......................................................... Plumber's License No ......................................................... Electriman's License No ..................................................... Other Trade's License No ................................................... 1. Location of land on which proposed work will be done. Map No ............................................... Lot No ...................... Street and Number ~'/~ [~//~ ~4t~(A.) ~ c~ ~.,~ f.~ .... :...~.~.~)../......(~ ......... ¢...~i~fa.~i..~.¥...~... 2.State existing use and occupancy of premises and intended use and 9t~cupancy of proposed construction: a. Existing use and occupancy ................................................................................................................................. b. Intended use and occupancy .......... ~ .... ~. .... ~ .................................................................... 3. Nature of work (check which applicable): New Building ....................... Addition .................... Alteration ..... :. ....... Repair ......................... Removal ......................... Demolition ........................ Other Work/..~?....~...7~.......~..../..d..~./.,.c.... ( Description)~-~_ 4. Estimated Cost...............................................~J O © ~ Fee ................................................................................................ (to be paid on hhng th~s apphcatmn) 5. If dwelling, number of dwelhng 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 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 in which premises are situated ................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .......................................................... 13. Will lot be regraded ............... ~ ................. Will excess~fill be removed from premises: [ ] Yes [ ] N~_ 14. Name of Owner of premises..~../.~.(.2..t.~.~.....~..~ ...... ~....~.j.tZ.~_--Ttrd.~.....Z~."i'' ....... (Address) (Phone No.) Name of Architect .................................................................................................................................................. ; (Address) (Phone No.) Name of Contractor ................................................................................................................................................. (Address) (Phone No ) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fro property lines. Give street and block number or description according to deed, and show street names and indicate whel er interior or corner lot. STATE OF NEW YOR, K, ) SS COUNTY OF . .~.-.,_ ~ .~..~k,.<,, ......... ) ...'X?x~-~x..~.. ~'..~. ~. ~-~.C~..~[..~'.,,..~. ~ ......... be,nD duly sworn, deposes and says that he ,s the apphcant above nam, (~me of tnd~vtdual st~nzg contract) He ~s the .~ .~q..~ ............................................................................................................ (Contractor, agent, corporate officer, etc ) of sa~d owner or owners, and ~s duly authorized to ~rform or have performed the sa~d work and to make and hie th~s apphcat~on; that statements contmned m th~s apphcatmn are true to the best of h~s knowledge and behef, and that the work wdl be performed m the ~ set forth m the apphcat~on fded therewith Notary Pubhc, .~~.~.[':~J? ~O~y' ~ ~ '-- O~ ~ ~,~, C , . .: .:% ...... .................... .......... --t (S~natureOf ap~ant)