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Home My WebLink About7196-z FORM NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFIGE SOUTH'OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~EMIS~S COMPLETION OF THE WORK AUTHORIZED) UNTIL FULL Permission is hereby granted to: Twin I'ork~ Fence pursuant to application dated .................. .A.~.~..~........~.~'.....!;...., ¥ Building Inspector. i ,, Fee $~1..~...00- ............ 1~.....:., and approved by the ! BuHdlng Inspeltor FOF,,M NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENZ TOWN CLERK'S OFFICE: SOUTHOLD, N. Y, proved .......... :.:.', ........... No. ....... t~uHamg inspect:) APPLICATION FOR BUILDING PrRMIT INSTRUCTIONS Application No. 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 t;o schedule. b. Plot plan showing' location of Jot 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 lhe 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 Deportment for the ~ssuance of o Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New 'ark, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or ~r removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, build ~g code, housing code, and regulations, and ¢o admit authorized inspectors on premises and in, buildings for necessary in~ ~ections. ............................. (Signatur of applicant, or name, if a corporation) ............... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, gener61 contractor, electrician, plumber or builder. ..... ............... .............................................. : ....... ........................................................................ 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 wh~h prop, qsed wo~ wilJ~ be done. Map No.: ..... i ................................... Lot,No ..... ,....,.~ .......... ~ Municipality ' State existing use and occupancy of premises and intended us~ and~occupancy of proposed construction: b. Intended use and occupancy / ~ ~ c ~ f L 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................... Other Work .. ,~,~escription) 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 ......... ~j..~. ........................... Depth ....... ~...~.,~...~'~. ........... 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 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 fil! be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premise~f/~.~-..~-~..,..~¢~..~ ...... Address~'~..¢.~.~¢~ ...... Phone No.~n/'6.~,,~'~..~.].. 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 NEW/YO/~/,, JJ COUNTY OF~..". ....... ................................................................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contracf) above named. He is the ................................................................................................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or awners, and is duly autharized to perform or have performed the said work and to make 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 forth in the application filed therewith. Sworn to before me this ._ of .................. . /I . · ......... T. BoKEN / (Sig~e o app 'cant) JUDITH