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Home My WebLink About7388-zTOWN OF SOUTHOLD i BUILDING DEPARTMENT TOW~ CLERK'S OFFICEI, SOUTH'OLD, N.. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) N°. 7388 Z Date ............ Permission is hereby granted to: ~z*Z.,, ........ .v. ~; ,~. ~h .~.~...~ ...... fL,, e ....... ~ .................. pursuant to application dated .................... -~tt.~y. ....... ~.~ ....... ~ ...... 1~...., and approved by the Building Inspector. Fee $~.~.,.~). ............ FOBM NO. 1 TOWN OF SOUTHOLDi BUILDING DEPARTMEHT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ....... ; ................................ , 19 ........ ; Approved ........................................, 19 ........ Permit No ....................... ~ ............. Disapproved a/c Application No ................................. (Building Inspector) APPLICATION FOR BUILDING INSTRUCTIONS a. This application must be completely filled n by typewr ter or in link and submitted Inspector, with 3 sets of plans, accurate plot plan to scale. Fee acco;"Binglto schedule, in triplicate to the Building b. Plot plan showing location of lot and of buildings on premises, rela{ibnship to adjoining premises or public streets o~ areas, and giving a detailed description of layout ofproperty must be draWnjon the diagram which is port 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 issueia Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the wo~k. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall hove been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for thel issuance of a Building Permit pursuant to the Building Zone Ordinance of the TOwn of Southold, Sulfa k County, New York, and other app cable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for remova or demolition, as herein described· The applicant agrees to comply with all applicable laws, ordinances, bu a~ing code, housing code, and regulations, and to admit authorized inspectors on premises and in, buildings for necessary i ~nsPections (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, generbl contractor, electrician, plumber or builder. Name of owner of pram ses 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 work will be done. Map No.: .:..~ ~ .... ,~' -,~, t Lot ~ ' ~ '- Street and Number .......... ~'~' Municipality State existing use and occuponcy of premises and intended use ant occupancy of proposed construction: a, Exisiting use and occupancy ........... .... ........................................ ~ .................................................. b. Intended use and occupancy -~ , , ,, ,, ~' · , .................................................................. 3. Nature of work (check which applicable): New Building,. ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ........ t...., ~,.(.~.,,~ ............................ .... · (Description) 4. Estimated Cost ............................................................ Fee .... ~ ...... , ............................................................................. ~ ~"' (t~O 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 .............. e ........................ Depth ...~.~.., ........................ 10. Date of Purchase ........................................................ Nome of Former Owner ................................ : ....................... 11. Zone or use district in which premises ore situated ............ ~.,.~ ....... ~.~ ......................................................................... 12. Does proposed construction violate any zoning Iow, ordinance or regulation: ........................................................ 13. Will lot be regraded . ........ t~:O .............. Will excess fill be removed from premises: (~'q] Yes ( ) No 14. Name of Owner of premises ............................ ~ ................. ... Address ......... : 'r ................. Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Nome of Contractor ...............b<......~ .................................... Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions froro property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STA'FE OF NEW YORK, COUNTY OF ............................. ;... ......................................................... being duly sworn, deposes and soys that he is the opp[icom (Name of ~ndwldua slgmng contract) above named. Fie is the .......................................... ;.,t:'"'"~ ............................................................................................................................ (Cohtroctor, 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 ore true to the best of his knowledge and belief; and thar the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this .............. · ~. ........ day of .................. ¢~.~..~. ................. , 19( ........ Notary Public, . ................................................... County (Signature of applicant)