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Home My WebLink About7135-z l~Ol~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) : N°. 7135 Z Date ............. Permission is hereby granted to: t~rect ~nd maintain a uti].ity -~t~z'a~e ~he~ at premises located at~'/s .~..?~s A~ ~.T'~'zl~e~ O~ ~2 ~e~a ~a}~t~uek. 'N.Y. ,. ......... pursuant to application dated . . ~ 2~ ~; , 19~.~., and approved by the Building Inspoctor. Fee $.1..?. ~ ..0..0.. .......... , nweCtor[ ..... FO]~I NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE' SOUTHOLD, N. Y. Fxamined 19....~... Approved t( _~ 19. Permit No.7t.../-.~. ~' '~'-,...~.~....... ........... Disapproved a/c ~.~~~_~---'"~.~____ l ~(Building Inspector) APPLICATION FOR BUiLDIIqG PERMIT ate ................................................ , ............ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with 3 set~ of plans, accurate plot plan to scale. Fee according fo schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout ofproperty must be drawn 6n 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 a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purbose 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 York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, buildihg code, housing code, and regulations, and to admit authorized inspectors on premises and in, buildings for necessary inspections. ......... i~'i~'~'~'t'~'~'~a'~'~ii'~;~]";~"~&'~'e, ........... if a car'~' ~'~)';~ii;~J ........ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name 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 Trade's License No ............................................... : x/ .~ Location of land on which ~pos~l wor~k~il[ be ~?e. Mo~qo.: .... ................... ~.~..~....~: ............. ~, ~ ~. 7~..~., .~. /~~. ~-,.~,~.~ . Street and Number ............................ ~ ............ 7~. .................................................................................................. / Muniqipali~ State existing use and occupancy o~ premises and in~ended use an~ occupancy of proposed construction: o. Exisiting use and occupancy .................. --.~:'~:z'"'~~ ................................................... '"'"'" b. Intended use and occupancy .................................. ~:'~~ '~~~_ .............. .................................................................... ' '" 3. Nature of work (check which applicable): New Bui'lding .................. 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 units ............................ Number of dwelling units on each floor ............................ If garage, number of c~rs ............................................................................................................................................. 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 o~terations ar 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 ................................... .~:~.... ~,~pth ................................ 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 premises ............................................ ~'....~.. Address ............................. i.. 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-b~ck 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. ...................... ~.., .......................... ;~ ........................................... being duly sworn, deposes and says that he is the apphcanl (Name.s-of, ,nd,wdual. ~.s,gn~g 'co trac~) above named. "' He is the ................................. ; ............................................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and Js duly authorized to perform or h~ve 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 ~or~ will be perform~d~ip the ~nner set forth in the application filed therewith. Sworn t~ore me this / ~"~' .... L.. ;~:/ .,:~"~; ....;¢~ ~ ~c (~' ........................ day of ............................................ , 19 ........ ..,~ Noto~ Public, . ................................................... Coun~ (Signature of applicant)