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Home My WebLink About7130-zFORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT! TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISI~S UNTIL CQMPLETION OF THE WORK AUTHORIZED) FULL 7130 Z Permission is hereby granted to: : pt premisos OCOTO0 o~ ......................... x,....'.; ......................................................................................... pursuant to application dated .......................~...~ ....... ~.?.../~.:{..~.., I~..c. .., and approved by the Building Inspector. Fee $ J ~. Building Inspector Application No. ~ - (Bui ding inspector) : __ APPLICATION FOR BUILDING RERMIT 'Date ................................................ , 19 ............ INSTRUCTIONS This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Build~3! Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according ~o schedule. b. Plot plan showing location of lot and of buildings on premises, reJatibnship to adjoining premises or public streets ~ areas, and giving a detailed description of layout ofproperty must be drawn ~n the diogFam which is part of this applicatic~, c. The work covered by this application may not be commenced befor~ issuance of Building Permit. t' ' d. Upon approval of this application, the Building Inspector will issue la Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the war[<. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupar~ shall hove been granted by the Building Inspector. ~vt~u¢ ~ APPLICATION IS HEREBY MADE to the Building Deportment for the~issuonce of'a Building Permit pursuant to t~fe Building Zone Ordinance of the Town of Southold, Suffolk County, Newiyork, and other applicable Laws, Ordinonces~ Regulations, for the construction of buildings, additions or alterations, or .~or removal or demolition, as herein describ~ed. 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 idspections. (Signatu.~e of appl!C~nt or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises ~ ' 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 Zrade's License No ............................................... I. Location of land on which proposed work will be~done. Map No.: .-.i ....................................Lot ix~z ........... ] ............ Mup 2, State existing use and occupancy of premises and intended use an~] occupancy of proposed construction: a, Exisiting use and occupancy ..................................................... ~, .......................................................................... b. Intended use and occupancy ...................................................... 3. Nature of work (check which applicable): New Building .:.' ............... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................... Other Work ................................................. .... (Description) 4. Estimated Cost ............................ ~ ........' ....................... Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling Hnits ............................ 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 aJterations 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 ..................................................................................................... ]2. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. ~Vill 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 YORK, [ c c COUNTY OF ~-o.J ................................................................................................. being duly sworn, deposes and says that he is the applicanI (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 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 ........................ day of ............................................ , 19 ........ J Notary Public, . ................................................... County