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Home My WebLink About6705-z FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTFAENT TOWN CLERK'S OFFICE SOUTHGLD, N. Y. BUILDING PERNtIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°. 6705 Z Date ............ i ............... ~Z.. 3 , 19...7.3. Permission is hereby granted to: R~e~.t,. ~ ~...W~u0a~le~ ................ ', ................. at premises 'located a~ ........ ]~.-~ ............. ]t~i.~.~,.~.k ......... ......................................................... pursuant to application dated '. .......................... ~. ....... ~...~...~., 19.~.~,~ and approved by the Building InspeCtor. Fee $"~'~w~O'"' ....... FOI~M NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. Examined ~. ~¢ ' ' ' / ~-; 19 ........ Application No. ~' ' . Approved ....... i ................................ , 19 ........ Permit No, Disapproved a/c ...... ~,,~ , .~ ....................................................................... ................ .................... /......:: ......... ................. ,/......: ........................... (Building I nspect/9~" APPLICATION FOR BUILDING I~ERMIT Date ................... ..~...:..:;.7..~. ............... , 19.../..?¢..,. INSTRUCTIONS o. This application must be completely filled in by typewriter on in i!nk and submitted in triplicate to the Building Mspector, with 3 sets of plans, accurate plot plan to scale. Fee according ,fo schedule. b. Plot plan showing location of lot and of buildings on premises, retati6nship to adjoining premises or public streets o~ areas, and giving a detailed description of layout ofproperty must be drawn On the diagram which is part of this application. c. The work covered by this application may not be commenced befor~ issuance of Building Permit. d. Upon approval of this application, the Building inspector will issue a Building Permit 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 Zone Ordinance of 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 laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engi~qeer, generbl contractor, electrician, plumber or builder. Name of owner of premises ........................... 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 Traders License No ............................................... 1. Location of land on which ~roposed work wi~ be done. Map~No.: ....' ..................................... Lot No ......................... Street and Number ........ ,~.~...4..%....~.'.~...~...U..?.,~....~m... ...... ~..~.....~. ............. ....... ..~....~......'.~...r~.~..!..~.. ...................................... Municipality State existing use and occupancy of premises and intended use an8 occupancy of proposed construction: o. E× s ti g use and o cupancy .............................................................................................. b. Intended use and occupancy ........................................... ~.... .......................................................... 3. 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 ............................ D~th ........................ Height .................... Number of Stories ..................................................................................................................... 9. Size of lot: Front .................... ~..~ .......................... Rear ...........~.~.?. ..................... Depth 10. Date of Purchase ....... ~..e.~.....~..~.~.~'. ....................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 ..~ ...................... WUI excess fill be removed from premises: ( ) Yes ( ) No ........ ........... No. Name of ArchHect .............................................................. Address ................................O~one No ....................... Name of Contractor~.?~..Z.~.~.&~¢..~.~[.~.~:_...~.~.. Address ~) ~ ~,)~ Phone No. PLOT DIAGRAM I_ocafe clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions ~rom property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEWc-Y,,O~/~ COUNTY OF .~..%. ....... )' ' ............................ ~4~..:........:.; ................................................... being duly sworn, deposes and says that he is the applicanl (Name of individual signing contract) above named. He is the ~~( ontractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform 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 performej~ in the manner set forth in the application filed therewith. Sworn to before me this/' I /'1 , .................... day of ...... Notary Pub c, ~ .............. !. County r..~./..~ ~.~.~~ , ' (~ig n a t u ~'~'o~' '~i[~'~'r~') ..................