HomeMy WebLinkAbout6548-z FO~V NO. ~
TOWN OF $OUTHOLD
BUILDING DEFARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
6548 Z
Date ......................... ~ ......... 8 ........... , 19.~.~..
Permission is hereby granted to'
........... ~t~i~u~k ...........................................
~ o .Er~c.~.~-~a-~u-taf~....~.t...s2ockade..~nce ....... ~/S..ya~& ...................................
at premises located at ..... ..~.,,/,.~,.....~.,~3~.,e,....,L~,e. ...... (..P,~,.T......]~.,J .............................................................
...................................................... 8~h~&...~.~ ........................................................................... ·
pursuant to application doted .........................~.y .......... 8 .......... , 19..$Z~., and approved by the
r3uilding Inspector.
(~uildJng I~'ector)
APPLICATION FOR BUILDING PERMIT
19
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector,~,,'~j~
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 areas, and ·
giving a detai~ed description of layout of property must be drawn on diagram which is part of this application.
c. The work covered by this application may not be commenced before issuance of Building Perm t.
d. Upon aPProval of this application, the Building Inspector will issue a Bud ng Perm t to the app cant. Such permit .shall be kept:~t}
~mises available for inspection throughout the work.
e. ~1o building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have t~een
granted by the Building Inspector. '
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone
Ordinanca~f the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of
buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable lawl.
ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necalsary inspections.
(Signature of applicant, or name, if a corporation)
(Address of applicant)
plicent is owner, levee, agent, emhitect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises
Builder's License No .......................................................... ~'~
Plumber's License No .........................................................
Electrician's License No .....................................................
Other Trade's License No ................................................... ,~/ ~
1. Location of land on which :2~
propo work ' /la~No.....~.~l~.~.
. done. Ma No ................................... Lot No .................
Street and Number ......... ~:1~. ..................................................... ~-e~-.~,~......... iiii..iiii
Municipality
2. State existing use and occupancy of p/~ises ~tended use and occupancy of proposed construction:
a. Existing use and occupancy ....~d~l~ .......................................................................................... :~'":'~' ..
b. Intended useandoccunancv :.~. .............. Z... ~/WC.S~'~ ...... ~
3. ~mNe'~bre of work (check which apolicable): New Building ....................... Addition ....................
Iter~!l_ ope..; ...........
Repair .....................Removal ...... Demolition ........................ Other Work .....................
(Description)
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 occuoancy, 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. Size of lot: Front ...................................... Rear .......................................... Depth .................................................
10. Date of Purchase ..................................... Name of Former Owner ............................................................................
11.' Zone or use district in w. hich premises are situated ....................................................................................................
12. Does proposed construction ~iolate any zoning law. ordinance or regulation: ................ ....................................... ....
13. Will lot be regraded .................................... Will excess fill be removed from premises: [ ] Ye.~ [ ] 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 distinctly all buildings, whether existing or proposed, and indicate all set-t ~ck dimensions from
property lines. Give street and block number or description according to deed, and show street name ~ and indicate wheth-
er interior or corner lot.
STATE OF NEW YORK, )
COUNTY OF ...................................................... )
........................................................................ ;~ ................................ being duly sworn~ deposes ~nd says that he is th~ applicant above named.
(Name of individual signing cohtract)
He is the ................................................................................................................................................................................................................
(Contractor, agent, corporate officer, etc.}
of said owner or owners, and is duly authorized to perform or have performed the $,aid work and to make and file this application; that all
, st_~em~e~,nt~s contained in this application are true to the best of his knowledge and belief; and that the work will be ~erformed in the manner
~' -4nplication filed therewith.
day of .................................................. 19 .............
........................................................... County
(Signature of applican ~} ·