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Home My WebLink About7172-z FOE~f NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES COMPLETION OF THE WORK AUTHORIZED). UNTIL FULL N? 7172 Z Permission is hereby granted to: . .z'. ~.~. g...~..~... ~.~.~.C..~ ............................................. ........ ~.~ez~o.~ .................................................. toeZ'e.q~...~.tlt],..t~.~.;t~,i~, fe~t3~...(.~) .................................................................................... at premises located at HObaI'.~........,. · ~.0.~:..~. ~f)~(l..~O~l. ......... i. ....... : .................................................. ...................... ~..~h~.~ ............ ~[.,.'~,-...~ .............. ,. ......................................................... pursuant to application dated .......... i~.pl'.~. ....... ~ ....., 1~...., and approved by the Building Inspector. Fee $1.'.~ .,..0...0. ............. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICEi SOUTHOLD, N. Y. Application No ................................. Examined ~'~f~/,,~,/ f 0 ' ' ' ................................ 19Z.../.. Approved................ '.: ...... '...(? ........... , 71 z Disapproved a/c .................... ;~ ~f:'~ .............................. ~(~uildino Inspector) ~Dofo ............. .~/. ............................. , 19 ............ INSTRUCTIONS o. This application must be completely filled in by typewriter o~. in ihk and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according (o schedu e. b. Plot plan showing location of lot and of buildings on premises, relati6nship to adjoining premises or public streets or areas, and giving a detailed description of layout ofproperty must be drawn ~n 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 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 Work, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or Sar removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, buildlbg code, housing code, and regulations, and to admit authorized inspectors on premises end in buildings for necessary in?portions. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, generc~l contractor, electrician, plumber or builder. 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 Trade's License No ............................................... Location of land on whi¢~ proposed.v~ork~ill be done. Map N~o.: ..... :...~ .............................. Lot No .......................... Street and Number ..(~./~..~...,.....~...~..~.[..,....~....~'.~..~..~.~....,~.~.~-:....~'/. ............ · .~..~...?'..~....~...D. .......... ! Municipality State existing use and occupancy of premises and intended use andJoccupancy of proposed construction: b. intended use and occupancy ................................................. .~,:,. ................................................................... Nature of work (check which applicable): New Building .................. Addition .................. Alteration ................. Repair .................. Removal .................. DemolitJo~ .................... Other Work .................................................... (Description) [:stimated Cost ......................................... ............. Fee ..... /. ................................................................................... (to be paid on filing this application} If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, number of cars ............................................................................................................................................. [f business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 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 ................................ Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................... Size of lot: Front ........................................................ Rear .......................................... Depth ................................ Date of Purchase ........................................................ Name of Former Owner ........................................................ Zone or use district in which premises are situated ..................................................................................................... Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ Will lot be regraded . ........................... Will excess fill be jemoved from prem,ses: Yes ( ) No Nome of Owner of r ~d No ....................... Name of Architect Phone No ....................... Name Phone No ....................... set-back dimensions from treet naives and indicate 10. 11. 12. 13. 14. Locate cJearJ' property lines. whether interior or STATE OF NEW YORK, [.S.S COUNTY OF ................................ ................................................................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. 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 file this application; that oil statements contained in this application are 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 before me this ........................ Gay of ............................................ , 19 ........ ~~~ x qature of applicant)