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Home My WebLink About9038-z FOR~T~ NO, ! TOWN OF $O~TNOI.D BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exomined .... : ............ proved ...... ...... ....... , ,erm,t ...... ~sapproved a/c ......................... ~;.;;. .................. ~.~ ...................................... ' ':?' ..... '~'~uilding Inspe~¥~';i ............................... Application No...~ ......................... APPLICATION FOR BUILDING PERMIT Dat~..~~~' ~ 19.....~...~... INSTRUCTIONS a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of Iot 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 on the diagram which is part of this 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 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 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 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, building code, housing code, and regulations, and to admit authorized inspectors on premises and ir~ buildings for necessary inspections. ....... ................. of applicant, or name, if .a corporation) .................. (Address of dpplicant) ~' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~-~ ~-~-~4- -- j ..................... ~....~ ................. , ................................................................... Nome of owner of prem,ses 4.,~¢'..(..,¢.~.~....,,~.'~:~ ~ ~x: ...................... 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 ............................................... 1. Location of land on which pressed WO_0~rk will be dc(ne//Map N,o-~.~...7~...~dX:-.-.-.-.-.-.-.-.~,,~. Lot No ..... .."~...~. .............. Street and Number ~..~...).....~..~..~.-.~..4/_Z~...~/. ....... ~...~.:..(~.~~~../....~..~,,/.. ....................... ' // 6/~unicipality 2. State existing use and occupancy Of p~.r,e, mises and intended use and occupancy of proposed construction: b. Intended use and Repair .................. RemovaJ/ ................. Demolition ....... x/:'~ ........ Other W,o, r4~..~..~~,~-//"~~ ? '~ ~ ~/0 ~ (De~ni~, 4. Estimated Cos~ .................. ~.~.~ .................. ~ee .g..~/.. ................................................................................. (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 ~rs ............................................................................................................................................ 6. If business, commercial or mixed occupancy, spec ~y nature and extent of each ~pe of use .......................... '~/ ~ /' Depth 7. Dimensions of existing structures, if any: Front ...... ~ ................ Rear .................................................... Height ........................ Number of Stories ........ ~. ................................. ;/~;.~. ................................ ~ ~ ............ .. , ~ Dimensions af sa~ structure with alterations or additions: Front ......... ~.~ .................... Rear ............................ ~ep,h ........ ~.~:--' ............. ~h, ............................ ~mb~, of S,o,~ ....... .~ .................. 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................... 9. Size of ~ot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ....... Name of Foyer Owner ........................................ ................................................ // /_/z/ 1 1. Zone or use district in which premises are situated ................... /....1 ........................................................................... ]2. Does proposed construction violate any zoning law, ordinance ar regulation: .Z'.....~..~....~ ........................... wi,~ ,o~ ~e ,~,,ad~d ...~ ................ W"' ¢~¢.~ ~" b. ,emo,e~~~ ~ 14. Mome or Architect ~~ ............... Addross .,. ~hon~ ~o Mome of Controctor ............................................................ Address ................................ ~hon~ ~o ....................... PkOT DIAGRA~ [.ocoto clearly ~nd distinctly oll buildin0s~ whether existin~ or proposed, ~nd indicate oll set-~ck dimensions {rom property lines. Giro street *nd blode~ 9umber or description occordin~ to deed, and show street n~mes ond indicate ~hether interior or corner lot. ...4'--// Swom~efore me this ........................ day of ..... ..~.?.~.~.~-.?.~..~. ................... , Ic7.~. ..... Notery public, 8u£~o].k County / term Expert, s March 30, )?,~ '" (Signature of applicant) STATE OF NEV~I.~Y~ I ¢ c COUNTY OF~l,iiit~[.~li...]~..~ bmng duly sworn, deposes and soys th~l~ he is th applico (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 applicatioo; that all statements contained in this application are true to the best of his knowledge and belief; and tha~ the work will be performed in the manner set forth in the application filed therewith.