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Home My WebLink About7157-z(THIS PERMIT MUST BE KEPT ON THE P{{fMISES UNTIL FULL COMPLETION Of: THE WORK AUTHORIZED) Ne. 7197 Z April li'OR,~ NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ......... ..... ~ 7..l.~..c....7....~... ......... ...... . ....~~ (-Building Inspector) / APPLICATION FOR BUILDING PERMIT Application No..2.L....~....i~.. ........... i NSTRUCTIONS a. This application must be completely filled in by typewriter o~ 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 plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets o~ ureas, and giving a detailed description of layout ofproperty must be druwn on the diagrum which is part of this upplication. c. The work covered by this applicution may not be commenced before issuance of Building Permit. d. Upon approvul of this application, the Building Inspector will issue o Building Permit to the upplicant. 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 shull have been grunted 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 upplicant agrees to comply with all applicuble laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signa{~l~ o~/applicont, or name, if ~.~c~oration) .... : ....... , ............. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, el'ectrician,'plumber" ' '~~~)~ I~[d~r. 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 Trode's License No ............................................... /g / / / . /?~ Location of Io~ on wh,ch proposed w~k will b, dane. My Street and Number ......------ ~ ~,,~.~:~.~..../.C~.~. ............ ~.~~ ...................................... Municipali~ State existing use and occupuncy of premises and in:ended use and occupancy of proposed construction: b. Intended use and occupancy ..................................................... ~ ~ 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .................. ~,e~noval .................. Demolition .......... ~, ........ Other Work ................................................ ...... c~ ~' (Description) 4. Estimated Cost .....~.Z..~.Z..~.....~....~ ........................... Fee ~ Z..~...'...~ .................................................................. (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 c~rs ...... ./.. ................................................................................................................................... 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 ..... /.~..J(~.... ............ Rear ...../.~..~ ..... Depth ....~ ........ Height .................... Nu~mber of Stories ........................................ ::...: ................................................. ~..~:.....~--~ ...... Rear 9. Size of lot: Front ........ ~...~.. ........................................ ........ ........................... Depth ...... / / ~ fFr r ner ,~....~.. ~7 ....~.......~. 10. Date of Purchase .................. .~..:....'.~... .......................... Name o o me Ow ....................................................... 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' . ........................... Will excess fill be removed from premjses: (,) Yes ( ) No 4. Name of Owner of premises ..~./.. re hone N Name of Architect .......................... .L/ ........................... q. ..... 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 ~,~roperty lines. Give street and block number or description according to deed, and show street names and indicate hether interior or corner lot. - ................. :~~~.....~.~..~ ....... b~in~ duly sworn, doposos ~nd s*ys thor he is the (Mo~o~dividu~l sionin~ contro~ ~bove nom~. He is the ................................................................................................................................................................................. (Controctor, ooent, corparote officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to rake and file this application; that all statements conta:ined in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set fo~h in the application filed therewith. BARBARA ~. HAURUS N0ta~ Public ~n ~e State of New York No. 52-6806770 Residin8 in Suffolk Coun~ / Core.ss/on Expires March 30, 19 ~ ~