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Home My WebLink About8962-z FORM NO. 1 TOWN OF SO~TJ'IOLD BUILDING TOWN CLERK'S OFFICE SOUTHOLD, N. Y'o Exomined . ~ [ ~ 19 ?~. APPLICATION FOR BUILD/~IG PERMIT Date ................... ......... ~. This opplic~tion must be completel~ {illod in b~ ~powriter o~ in ink ond submittod in triplic~to to the Buildino~' Inspector, with 3 sets of plans, accurate plot plan to ~ale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or Dublic streets et areas, and giving a detailed description of layout ofproperty must be drawn on the d agram wh ch is pa~ of ~his application c. The work covered by this application may not be commenced before issuance of Building Permit. ' d. Upon approval of this application, the Building [nspect0r will issue a Building Permit to the applicant. Such permit~ shall be kept on the premises available for inspection throughout the work. e. No bultding shall be occupied or used in whole or in part for any purpose whatever until a Ce~ificate of ~cupancy~ 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 alteraHons, or for removal or demolition, as herein described.~ The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and i~ buildings for ~essa~ i~pections. '~ ot/opp ' , name, i{ ~ corporation) ' ........ ....... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......Name~"4~'//Z/~"Z~'of owner of ......................................... premises .~..~...~/....~.......~.~-~./~.i ............................................................................................. ~. Zx~..~.~.--~.Z~.,(~.~..~.../~..~..../??'....~.'.~'''I'III ...... i'iiiiiiiiiiiiii applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ........... JiJ....c~......~....~ .................... Electrician's License No ..........~.....-h~.......~.... ................. Other Zrade's License No ............................................... Location of land on which proposed work will be done. Map N~o.: ....~...~.~...~.'../'~. ........................ Lot No.....Y.~./. ............. Street and Number .~..~.~.~/j~.~c~/J.~'~4~.~Z1.~P~.~`~..~.:?..[~.~.~D.~z~.~.~~~.~. ............................. ( }J/=/~/¥~COTC ~ Municipali~ S~ate existing use and occupancy of premises and intended use and 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 .................. Demolitior ..................... Other Work ................................................ ~,~ ~' t/ ~ (Description) (to be paid on filing this application) 5. If dwelling, number of dwelling units ....... J ................... Number of dwelling units on each floor ............................ If garage, number of cars ...~ ...................................... i .............................................................................................. 6. If business, commercial or mixed occupancy, specify natu~:e 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 ..... .g.~. ................ Depth .. 4~..~ ............... Height ./ ................. Number of Stories J ......................................................................................... 9. Size of at Front .... L..~...~..:.~'...~. ................................. Rear ....~...r')...~.:...~..(~.. ............ Depth .~...~'...~..:...~..~. .......... ?=.~l__) Z~one or use district in which premises are situated ....... ./TT&:.....~..~C..: ..................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .~.C~. ................................................. 13. Will lot be regraded' ...~t..1~.. .............. Will excess fill be removed from prer~ises: ( ~"Yes~ () No Name of Architect .'.~.~t~A..~f~fbe/. .................................... Address .?,0..~.t;¢~).~,.~..J,//Zf~:~.f~Phone No ....................... Narne of Contractor ............................................................ Address ................................Phone No ....................... PLOT DIAGRAM Locate ~clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from and show street names and indicate property lines. Give street and block number or description according to deed, whether interior or corner Iol. STATE OF NEW,_Y__QF~K.,-- I ¢ c COUNTY OF ...~.u..~.?..~... ............ ................................................................................................. being duly sworn, deposes and says that he is the opplic~m (Nome 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 ali statements contained Jn this application ore true to the best of his knowledge and belief; and that the work will be performed in the manner set fo~h in the application filed therewith. Swo'n to before me this 4~h . . ~v~ ........................ aay OT ........ ,.~otaff Public, ..~..,~ ............ L.[~.....~ ........... y.~oun~ .... ~,- ....................................................................................... F~ ,.~ '~_,., ,~ /,. ~ . ,~ (Signature of applicant) SURF. CO. D~.,OP ,E*L),,, ~.W~, ,, ,,, ,, ~,, E.T OF FOR APPROVAl. OF CO~S~ON ~LY ' TH~ WATB SUPPLY AND SEWAGE DATE; ~ ~ ~ ..... Ol~L ~Y~TEM~ FOR THIS H. S. R~F, NO.: '- ~ ~ / STAND~ OF SUFFOLK CO. DEPT. ~ OF H~LTH,