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HomeMy WebLinkAbout7156-z FOP~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPART/V~E~IT~ TOWN GLERK'S oFFIGE SOUTHOLD, N~. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMIS~ UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: at premises located at ..;~.,Y~..~:la;l~..,~O~;!, .......................................................................................... N~tt~, tuek N · Y. ..' ..... pursuant to application dated ........................,~tZ',l~L....~. ............. 19~. .... and approved by the Building Inspector. Fee $.t ~r.,.O..~. ........... i/ ilding nspe ~0~,~[ NO. 1 TOWN OF SOUTHOLD i BUILDING DEPARTMEN~ TOWN CLERK'S OFFICE~ SOUTHOLD, N. Y. Examined ..................................... , 19 .. Application No. ~/'/C-_~ Approved ,, 6~ 197..c./... Permit No. 2//4~/ ~'~-'% Disapproved a/c ~,.,~.~_~......~.~,~ ~ (Building InspectOr) APPLICATION FOR BUILDING PERMIT Dote ................................... , ,NSTRUCTIO,S a. This application must be completely filled in by typewriter or in ~k and submitted in triplicate to the Building Inspector, with 3 set~ of plans, accurate plot plan to scale. Fee according t0 schedule. b. Plot plan showing location of lot and of buildings on premiseS, relatic~nship to adjoining premises or public streets or 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 ~ Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the world. 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 f~r removal or demolition, as herein described. The applicant agrees to comply with all .applicable laws, ordinances, buildi6g code, housing code, and regulations, and to admit authorized inspectors on premises and in. buildings for necessary inspections .. c ................. (Signatur9 of applicant, or name, if a corporation) ...... ....... ....... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, generdl contractor, electrician, plumber or builder. .......................... Name of owner of 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 Street and Number .~..~-.......~..~. ....... .~...~.~/.../...,..~..(~t..~..(.~ ........... i~-..'...~.: ....................................................... Municipality 2. State existing use and occupancy of premises and in~ended use and ioccupancy of proposed construction: a. Exisiting use and occupancy ........ .~...~.,.(.~........~....x~...~, .'..~...~....... j:~....~..~.~...~.... ~ ....... .~,....~ ........................ b. Intendeduseandoccupancy 3. Nature of work (check which applicable): New Building .................. Addition .................. z_.- ~___ ~~Al~r°ti°n,' ................ (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 ..................................................................................................................... 10. Date of Purchase ........................................................ Nome of Former Owner ........................................................ 1 1. 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 ............................ Will excess fill be removed from premises: ( ) Yes ( ) 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 whether interior or corner lot. STATE OF NEVv't:~r'Ot~, t S S COUNTY OF ~,~-~....~'..~.z.~,.~'.~'.,..J' ' ................................................................................................. being duly sworn, deposes and says that he is the applicon (Name of individual signing contract) above named. //L.__~ . _~7 He is the ............ (-~¢~.~~ ............................................................................................................................. (Contractor, 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 fil this application; that all statements conta:ined in this application are true to the best of his knowledge and belief; an, that the work will be performed in the manner set forth Jn the application filed therewith. Sworn to befcre me this .............