The URL can be used to link to this page

Home My WebLink About7428-z FOEM NO. ~ TO~N OF $OUTHO/D BUILDING DEF~RT~ENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7425 Z Date ............ i ............ Jzt:L~ ....... .~.o~ ......... , 19.~.~k.. Permission is hereby granted to: ~.L'.;~.,,..~..d.,?~.....!~.~:~,.t~,~::.J~ ................................. 4z;:~-L:,]:i ;. ;.:e:U:taJn 6.['t stock4:de e:aclos'u~e - sld~ yard et premises located ~t ......................................................... ........ ~ ............................... ................................... x~x~.....t ~.~.e...,,~4~ ~ ~;'ago ~ 197~' pursuant to application dated .......... '.,...E..:~:~r- .......... ?.~....,,,./:.-, .... !... and approved by the Building Inspector. Fee ~,tP* ~0 TOWN OF SOUTHOLDi BUILDING DEPARTMEN1T TOWN CLERK'S OFFICI~ Exomined ~ ................... r ........... , 19. . Approvedl./. ....... ............... .~ ............. , 19./....(. Permit No .... ....- . .. Disapproved o/c APPLICATION FOR BUILDING P]ERMIT ~ ....... ...... INSTRUCTIONS Application No....~- .......................... a. This application must be completely filled in by typewriter o~ in iink and submitted in triplicate to the Building Inspector, with 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, relaffonshio to adjoining premises or public streets areas, and gw~ng a detaded 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 befo~.e 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 woik. e. No building shall be occupied or used in whole or in part for any pu?pose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for thei 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 w th all app cable aws, ordinances, building code, housing code, and regulations, and ,admit authonzed inspectors on premises and m buddings for necessary ~r{spechons (Signatu~'e of applicant, or name, if a corporation) (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, gener~al contractor, electrician, plumber or builder. Name of owner of premises ~ .................................................................................. If applicant is a corporate, signature of duly authorized officer. Location of land on which proposed work will be done.xn-- ~ ,--~., ~nM°P No.: .... ................ i.~:. ................. Lot No ......................... Street and Number ..................................................... .~.,.~....~.~.Lt~......~.~..7.,.,(~..~..~.~....~..~.. -- ......... ! Municipcility State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Fxisiting use and occupancy ............ ~ ......................................................................... b. Intended use and occupancy ...~.~....~:.~..~ ................................................................. Nature of work (check which applicable): New Building'. ................. Addition .................. Alteration ............... Repair .................. Removal .................. Demolitior, .................... Other Work ~ ................................. (Description) 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. Date of Purchase ........................................................ Name of Former Owner ..~...~.:...~.~ ................. 1 1. Zone or use district Jn which premises are situated .................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ,~r.¢~ ................................................. 13. Will lot be regraded . ........................... Will excess fill be removed from premises: ( ) Yes ( ) 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-back dimensions fror property lines. Give street and block number or description according to deed, and show street names and indicot, whether interior or corner lot. cou.T¥ ................. ~f%.~.~...~..~...4~,..~.;~..~.. ....................... being duly sworn, deposes ond says that he is the opplican~ /~ (NgCnre of individual signing contract) He is the ................ ~-~~..~ ................................................................................................................. (Contractor, ~gent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and this application; that all statements contained in this application are true to the best of his knowledge and belief; that the work will be performed in the manner set fo~h in the application filed therewith. Sworn to before me this ,¢ ~ ~ _¢ Noto~ ~ublic, . .......................... [ ....................... Coun~ .... ~ . ................................... ~ (S'onotu~op~lic~nt)