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Home My WebLink About7197-z FOI~M NO. TOWN OF SOUTHOLD BUILDING DEPARTMENTi TOWN GLERK'S OFFIGE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~EMISE~S UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: ; ........ ~,.~..~.u~g ................................ ~ ................. at premises located at ....... ]~l~¢..~[t~..J~Olk...RC~9,([ ..................... i .................. ,'; .................................... pu~:suant to .applieat!on d~ted .................... ,~,p~&J~...~.l.0 ......... Building Inspector. Fee $..!.~,t...0~.. ........... ..... , 19.~t.,~and approved by the ............... Building I'n.~5~ctor ] FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE! SOUTHOLD, N. Y. xam ned Approved 19 ..../.. Permit No...l..f,....f...~.......~ ..... Disapproved Date ..................................... INSTRUCTION$ a. This application must be completely filled in by typewriter o¢. in i~nk and submitted in triplicate to the Building Inspector, with 3 set~ of plans, accurate plot plan to scale. Fee according {o schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets 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 b Building Permit to ihe applicant. Such permit shall 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 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 ~ork, and Other applicable Laws, Ordinances~ or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, os herein described. ~t~e applicant agrees to comply with all applicable laws, ordinances, build~ng code, housing code, and regulations, and to ~Sadmit authorized inspectors on premises and in, buildings for necessary inspections. .... ........ : ........... (Signature of applicant, or name, if a corporation) (Address of applicant) Stale whether applicant is owner, lessee, agent, architect, engineer, generOI contractor, electrician, plumber or builder. Nomo o~ ow~o~ o~ p~Jsos ....... :. ......................................................................................................................................... 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 which proposed w~ork will be do~e~ Map No.: ....i. ......................... ,....~... Lot No ......................... Street and Number ./..~.~..~.....,~..'?...~../T~.¢...~....~.........~...~..' .................... .~.~~.'.~..~....~... // Municipality State existing use and occupancy of premises and in{ended use and occupancy of proposed construction: a. Exisiting use and occupancy ........... ~ ...... J....:.r..~A.~.~. ...... ,LJ.,¢,~ ,,~S..~,,.~.,,...~..f..(,~. ............................................... t I b. Intended use and occupancy .... Nature of work (check which applicable): New Building .................. Addition .................. Alteration, ................ Repair .................. Removal .................. Demo t an ........... Other Work .......................................... ' .... (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, Jf 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 ........... Z.~..~,.~. .................... 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 fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of pre~t ¢: ........... Address,A/¢.~(,.~¥~2¢,/~'../~.)0 No. Phone~ -- Name of Architect ................................ ~ .............. ~ .......... Address ................................ Phone, No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctl'y 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 YORK.,, tS S COUNTY OF ....._~..~,r.~l~.,.~..:.J'__ _ ' ................................................................................................. being duly sworn, deposes ~nd s~ys that he is the ~pplic~m (N~me of individual signing contr~c0 ~bove n~med. 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 ond file this application; that all statements contained 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 therewJth. Sworn to before me this ......... o, ....... ........ . ~ ' - / (Sign~¢re of applicant) Jugm~ T. ~OKEN ( / -p