The URL can be used to link to this page

Home My WebLink About6448-z FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) 6448 Z Permission is hereby granted to: · .i~e~.~e~...9.~r.~$.."- .~..~t..f.e.. ............. , .............. ~oat~old at premises located at ...... F~.~..~L~.J~O;~C~L..I~.O&¢I ............................................................................. ................................................. ~outh~l~ ....... N.,.Y.,-: ......................................................................... pursuant to application dated .......................~.. ......... 30- ........ :t', 19..~..~., and approved by the Building Inspector. Fee $ .1.~.,~.(~ App roved ............. .~.~. ........................ , FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Disapproved o/c ............................................................................................ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with~, 3 sets of plans, accurate plot plan to acale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationst~ip to adjoining premises or public streets or areas, and~ giving a detailed description of layout of property must be drawn on diagram wh~Jch is part of this application, c~ c. The work covered by this application may not be commenced before issuance of Building Permit. ~ d, Upon approval of this application, the Building Inspector will issue a Bud ~g Perm t to the applicant. Such permit,shall be kept on the premises available for inspection throughout the work. : e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy 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 the Building Zen Ordinance of the Town of Southold, Suffolk County, New York, and other applicabl~ Laws, Ordinances or Regulations, for the construction et buildings, additions or alterations, or for removal or demolition, as herein describedJ The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, ,,or na~l~f a c~:~rporation,) (Address of 8pplicsnt) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................................................... Plumber's License No ......................................................... Electrician's License No ..................................................... Other Trade's License No ................................................... 1. Location of land on which proposed work will be done. Map No ............................................... Lot No ......................... Municipality 2.State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .~.~.~.~...':7~... Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration ............... 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 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. Size of lot: Front ...................................... Rear .......................................... Depth .................................................. 10. r)ate of Purchase ..................................... Name of Former Owner ................................................................. ~ ........ 1 I. z.one or use district ~n whmh premises are s~tuated ...................~.. .............................................................................. 12. r)oes proposed construction violate any zoning law, ordinance or regulation; ......... ..~....0. ........................................... 13. Will lot be regraded ................/.,~,,-f¢-----7~ ,-3 ,.~ ..... Will excess fill be removed from ~remises'~ ]~Yes [ ] No 14. Name of Owner of premises ,~~....~.:.~.,f~. .......................... ~ ......................................... (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 from property lines. Give street and block number or description according to deed, and show street names and indicate wheth- er interior or corner lot. '~~/~ ~/()~"~ ~'-~'~ ~- being duly sworn, deposes and says that he is the applicant above named. (JJJ/'i~'~ne of mdwtdual st~,ng contract) He is tho .................................... ~~.~ ............................................................................................................................................... (ContracWr, agent, ?rporate officer, etc. j of said owner or owners, and is duly authorized to ~rform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. ~ .x ~ TERRI LEE ~K ~ (Signature o/~pplicdnt) ~ /