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Home My WebLink About8641-z l~O~NI NO. ~ TO~N OF $OUTSOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. . BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 8641 Z Permission is hereby granted to: pursuant to application doted ........................................................ , 1 ........ , and approved by the Building Inspector. Fee $..;.,..: ................ Building Inspector Examined ................. Approved ............. .~. Disapproved a/c ..... IEORlil NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N: Y. t y / z 19 ........ Permi No. .................. .,~. ~.~-~ ~z ...... ~....../..~ ............ / v (Building Inspector) Application No....~..?Z ........... APPLICATION FOR BUILDING PERMIT Dote ....................... .................. 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 lot 6nd of buildings on premises, relationship to adjoining premises or public streets o~ 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 in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) ..... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........................................ ~.~.Z.~' ..~zZ~.....f.o..P..., ..................................................................................................................... If applican~ is a cgrpp~te, signature of duly authorized officer. ..................... . (~,lo,~ne 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 lanc~or~hi~h pro, po~ed ,w, Qr~ will b~i~one. Mop No.: ........................................ Lo~ ......................... Street and Nurr(be~r ~.....~/~...:.......~-~ ................................... ~...". ................... ff~ ............ Municipality State existing use and occupancy of premises and intended use and occu, pa~ncy of proposed construction: b. Intended use and occupancy .................... .~ ........... ~. .................................................................................. 3. Nature of work (check which applicable): New Building~· ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolitior ..................... Other Work ........../...~.~. ~,~,. f..' ./..V_..~....~ ........ (Description) 4. Estimated Cost ................................... .~.....~..?..~..~..~....Fee ...................... .~....~...~...?....o. ............................................... (to be paid on filing this applicatiqn) 5. If dwelling, number of dwelling units ............................ Number of dwelling units an 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 ................... ,/...~...D. ............................. Rear ............. .~'..~...~. ..................... Depth ....... ...~'...~....~.. ............. 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 1 1. Zone or use district Jn 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 frgml ~l /~/~,n/~ ~Pr'emi~s: ~,) Yes ( ) No 14. Name of Owner of premises ......... Address~...~,~hone No...~.~.~/.~.O..q..~....~ ' 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 NEVCY~I~!/ Icc ......... _ .... ~~~....S. ............................ being duly sworn, deposes and s~ys that he is the applic~m / (Nam~of M~idual signing contract) He is ................................... (Contractor~"~ge~,"~'orporate of icer, etc.) the ~~ .......................... f .............................................................................. of said owner or owners, and is duly authorized to perform or have performed the said work and to make ~nd file this application; that all statements contained in this application are true to the best of his knowledge and belief; and thor the work will be performed in the manner set fo~h in the application filed therewith. Sworn to before me this ...... ..... ....... ................. / ........................ co.. ................................ ~~~~ / (Si~notureoropp,,cont)