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Home My WebLink About7292-z FOI~M NO. ~ TOWN OF SOUTHOLD i TOWN CLERK'S OFFICE SOUTHOLD, H'. Y. (THIS PERMIT MUST BE KEPT ON THE P'REMIS~S UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 7292 Z Permission is hereby granted to: - uuilding :ln~ector /~ I Building Inspector. Fee ~, ~..0...0. ................ TOWN OF SOUTHOLD BUILDING DEPARTMEN1 TOWN CLERK'S OFFICE~ ................. , . ~7'~L,q j ~ -- ~ 4 &~ Application No. ,.~.~ ............... ........................................ , 19.,..+ PermitNo. ~proved Disapproved a/c ...~.........~.......~......_..~........~...~ ................................................ ........................ APPLICATION FOR ~(~jRMIT ~ c{ INSTRUCTIONS a. This application must be completely filled in by typewriter o~ in ip,k and submitted in triplicate to the Building Inspector, with 3 setg of plans, accurate plot plan to ~ale. Fee according ~o schedu e b. Plot plan showing location of lot and of buildings on premises, relationship ~o adjoining premises or public streets o~ areas, and giving a detailed description of layout ofproperty must be drawn ~n the diagram which is pa~ of th s 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 wor~. 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 ~he construction of buildings, additions or alterations, or ~or removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, buildihg code, housing code, and regular OhS, and to admit authorized inspectors on premises and in. buildings for necess~n~ections. (Signatur~ of a~nt, or'~'~ a corpora~) .... (Addross o~ opplicont) State whether applicant is awry, lessee, agent, architect, engineer, general contractor, e ectrician, plumber or builder. ................................................ .................... i ..................... .......................................................................... Name of owner of premises If applicant is o 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 work will,be done ~Mcp No.: ..... ............ L~ No Street and Number ..... ~.,.~.-~.......~'.....'~....~...-~..k.~.~¥....§....'~O. ?.~...t~.. ....... ...~.~ .......... : ................... ! Municipality State existing use and occupancy of pren~ises and intended use andloccupancy of proposed construction: o. Exisiting use ond occupancy ........ /" '~'"~'"~".~'~..i ......... ~ .......................................................... b ntended use and occupancy .~.k . ' .~;:!...''' ' P ..~...~...~ ..... ........................ ......... 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................... Other Work ............- ......................................... :~', ~ ~ O~ (Description) 4. Estimated Cost .............. i:..~.....'....' ................. Fee ~', e (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 in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regdation: ........................................................ 13. Will lot be regraded . ........................... Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises .................................................... Address ................................ Phone 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-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 ~)BI~',/ .~ .~. I ~ ~. COUNTY OF ! ' '. ....... be ng dui;/ sworn, deposes (Name of individual signing contract') above nome.d. appli'~anf 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 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 bT me this ~ ................ - .... ........................... ........ ................. ....... .................... ~ ~ - JUDITH T. BOKEN (SignaTure at app~ cant) Notary Pubhc, Slate of New York No, 52-0344963 Suffolk Coun~ C~mmi~ion Expires March 30, 19~