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Home My WebLink About7647-zPermission tO BU!LDI BUILDII (THIS PER(V~IT ~UST BE KEPT COMPLE'rlO~ OF THE WORM 7647 ........................ ~... ~ ~t~..~.i: · ~ ...?.. ........ : .........: ~PursOant tb application at d Building Inspector, ~pproved by the Approved ........................................ , 19. FOF~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No. Disapproved a/c ..... ....................... .............................. Date ................. /il~O , 19 ? Y... INSTRUCTIONS o. 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 scale. Fee according to schedule. b. Plot plar~ showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout ofproperty must be drawn on the diagram ~hich is part of this application. 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 Building Permit to the appticant. 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 Lows, 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. ...................... (Signature of applicant, or name, if a corporation) ................. (Address of applicant) State whether applicant is owner, lessee, agent, architect, en31r.'eer, general contractor, electrician, plumber or builder. Name of'owner of premises ...~..x~z/x~'J~..,.,.~C-~~ .................................................................................................. 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 ............................................... Location of land on which proposed v/ark ~ll/(/.e/~e~lM~p No.: ~.~.~.r~i~.~, Lot N,~ ........ :......,.....,... Street and Number ...............~T~--~...~-/~ ............................................................... .~~J~.. I /' Municipality State existing use and occupancy o~remises and intended us, e and occupancy of proposed construction: b. Intended use and occupancy ....... L. ........ .(. ......... (....L.....' ". ........ .[......!....' ' '. ..................................................................... 3/ N'ature of work (check which applicable): New Building · ................. Addition .................. Alteration .................. Removal .................. Demolition .................... Other Work '"'v~"~ ~¥~"~i;~'~~~ ,v~ ........ ' .... Repair 4. Estimated Cost ................... ..~..~..~..~.,.~.. ..................... Fee ...................... /...~..'-~...~..~J .................................................... (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. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning Iow, ordinance or regulation: ........................................................ 13. Will lot be regraded . .................... ~ ...... Wi[,L, exc,ess fill be removed fr_om/pre~'~e~7/(/~) Yes ( ) No ,4. Nome of Owner of ......... Phon Nome of Architect .............................................................. Address ................................ Phone No ....................... Name of Controctor ............................................................ 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 whether interior or corner lot. STATE OF NEW~OJ[J~,/J~ COUNTY OF .~¢~Z..~.~. .......... ~'~ ...~ .......................... t.F ............................................................... being duly sworn, deposes and says that he is the applicon~ (Name of individual signing contract) obove named.~ -~- ~-~'-~ ~. He is the ...... ~~(;~~'~`~.~`~;~'~t~fi~`~t~`~`~`~-~` ~'~`~~ ............................................................... of said owner or owners, and is duly authorized to perform or have performed the said work end to make and file this application; that all statements canto'load in this application ere true to the best of his knowledge and belief; and thor the work will be performed in the manner set forth in the application filed therewith. Sworn to be~ore me this -- ., // JUDITH T. BoKEN / (5ign~/tu~'e o app icant) (00