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Home My WebLink About7179-z FOEM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTh~ENTI: 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? 7179 Z Permission is hereby granted to: [ ~ ~:tt 1~ ond opprovo8 by the pursuont to opplic~tion d~tod .................................................. ,...., ., Building Inspector. o~ ...... Building Inspector l~O~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICEI SOUTHOLD, N. Y. .................... ::...% ........... Disapproved a/c ...... .~........~.. ........................................................ ~... (Building mspectorJ APPI. ICATION FOR BUll-DING ~ERMIT ApplicationNo. 7/7~ Date ............................................. 19 ........... INSTRUCTIONS a. This application must be completely filled in by typewriter al~ in Jn:k and submitted in triplicate to the Building Inspector, with 3 set~ of pla,ns, accurate plot plan to scale. Fee according ~o schedule. b. Plot plan showing location of lot and of buildings on premises, relati~)nship to adjoining premises or public streets or areas, and giving a detailed description of layout ofproperty must be drawn j~n the diagram which is part of this application. c. The work covered by this application may not be commenced beforj~ issuance of Building Permit. d. Upon approval of thcs apphcat~on, the Building Inspector w II ~ssue p Building Permit to the applicant. Such permit shah be kept on the premises available for inspection throughout the wor,k. 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 theiissuance of a Building Permit pursuant to the Bu Iding Zone Ordinance of the Town of Southold, Suffo k County, New !York, and other applicab e Laws, Ordnances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors premises and on in buildings for necessar~ i~spections. .~ ~ ( (Address of ol?~licant) ,~/[l~ State whether applicant is owner, lessee, agent, architect, engineer, generbl contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License Na ..................................................... 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 ond Number ......... ~....~..~;~ ....... .................... ......................................................................... Municipality State existing use and occupancy of premises and intended use an~ occupancy of proposed construction: o. Exisiting use and occupancy b. Intended use and occupancy .................... ~ ................................ ................................. .f-. ................................... 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................... Other Work .................................................... · ~ u (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 ............................ Nu__mber of Stories ............. ~ ................ 8. Dimensions of entire new construction: Front .............. ~ ................ Rear .......... ~ ...........Depth ...... (..~ ...... Height ................ Number of Stories ........................................................................................... ~..~:.~ .............. 9. Size of lot: Front..................i.~...~;.?......................"~C'C) Rear ............. ~..O.. .................... Depth ................................ i0. Date of Purchase "'"'""'"'"'(.'~..'..?...7."'"'""'"'""'""Name of Former Owner ........ ~r~..Z...~..../....L....../T~.. ............... ....................... 11. Zone or use district in which premises are situated '~;~'i'r~'~'r~"'~'~"~ lotion' " ~ . 12. Does proposed construction violate any zoning law, u ........................................................ 13. Will lot be regroded~· ........................... Will excess fill be re~m_oved f. rom premises: ( ) Yes 14. Name of Owner of premises .................................................... Address ..~¢ttt.~/Z .................. Phon~ 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-b~ck 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. '~/4 STATE OF NEW YORK,.~ ...... ! ~ ~ COUNTY OF ............ ,-.?~.~ ......... ..~%. f (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 all statements contained Jn this application are true to the best of his knowledge and belief; and tho~ the work will be performed in the manner set forth in the application filed therewith. No.52-0344968 SuffoJk Commission ~xpi~os M~rch ~0,