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Home My WebLink About7193-zTOWN OF SOOTHOLO I~UILDING DF. PARTMEN'I TOWN CLERK'S OFFICE i SOUTHOLD, N. Y. SIGN (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°. 71193 Z Dote ............ ,.....~Lp~.:tZ ....... 25 ............. , 19..~.~.. Permission is hereby grontdd to: .~ ~, f,¢**:t,~.....~,.,.~..~...~.e.~.v.l.c ~ ............ .................. ' ig (£1 ~). ~ ~'t × 8it (32 .qrt) to erect and maintain, front ~,Tall .s n us , ~ s premises located at .}~..1~0.9.~ ........................................ ' ............................................................ ............................................... ~,~.tt £tu~k.....N.,~. ................................................, pursuant to application; dated ................ ~a~.......~, .......... ~;. ......... , 19~...f, and approved by the Building Inspector. i ~ Fee $:~*~0 .............. Building ~nspector I ~0~,,.~ NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMEhI~ TOWN CLERK'S OFFI~i SOUTHOLD, N, Y. APPLICATION FOR BUILDING ~ERMIT INSTRUCTIONS e. This application must be completely filled in by typewriter or in i~E and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to ~ale. Fee according ~o schedule. b. Plot plan showing location of Io~ and of buildings on premises, relationship to adjoining premises or public streets o~ areas, and giving a detailed description of layout ofproperty must be drawn bn the diagram which is pa~ 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 buiJding shall be occupied or used m whole or mn part for any purpose whatever until a Ce~ificate 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 ~ork, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or ~or 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 on premises and in, buildings for necessary inspections. State whether applicant is owner, lessee, agent, architect, engineer, generbl contractor, electrician, plumber or builder. If applicant is a corporate, ' duly ~uthorized ~ficer (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 which proposed work will be done. Map ~o~ ,..~l ................................... Lot No ......................... Street and Number .... ~.'~....~.....~.. ...... ~'~,~./...~.."!: ...... : .................................................................. i Municipality State existing use and occupancy of premises and intended use an~ occupancy of proposed construction: a. Exisiting use and occupancy ....... .~..~....~.,~ ....... ..~..<~.~.k~'. ..... .~ ............................................................. b. Intended use and occupancy .............................................................................................................. ~ ................ 3. Nature of work (check which applicable): New Building ...: .............. Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................... Other Work ..... /('.~' ..~......~ ................ (Desc~'ption) 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 ...................................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district Jn which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded .............. I~. .......... Wi. II excess fill be removecJ, from pre,raises: ( ) Yes (/-'~o 14. Name of Owner of premises ..~... ~.~.?.¢.r~ ...~. ¢. Add Name of Architect ................................................ ~.. .......... Address ................................ Phone No ....................... Name of Contractor .............................. ~ ......................... Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly ail buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, end show street names and indicate whether interior or corner lot. STATE OF NEW YORK, t ~ ~ COUNTY OF ..~O.~.F.~..0./~.~,~ ........~ ~'~ ........... ...~..1~.9~.~. ...... ~ ....... ~.~ ......................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contracf) above named. He is the ...................... ~.~..I.~.~ ........................................................................................................................... (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 in this application are true to the best of his knowledge and belief; and tha~ the work will be performed in the manner set forth in the application flied therewith. Sworn to before me this ......... ~.J~.. day of ........~.~. ............... , 19~. ~ / /~ . ,/ No, rv/& ic,. ................... ....... Co,, ..... .................... / I ~ (Signafure of applicant) '