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Home My WebLink About8460-z FOE~ NO. ~ TOWN OF! $OUTHOLD~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (TI~I~ER-'MI? MU~ ~KEPT O~N THE PREMISES UNTIL FULL CO'MP~ETION OF T~"~K AUTHORIZED)"~ N.o 8 60' PermiSsion iS hereby Z Date ... · Approved TOWN OF $OUTHOLD TOWN CLERK S OFFICE SOUTHOLD, N. Y. 19.~./. ..... Permit No...~....~ Application No. Z.~.....~...~. ............... ~ Disapproved a/c ~' (Budding inspector/ ~ APPLICATION FOR BUILDING PERMIT Date .............. ~.,~./i..?.: ..................... , 19..~....~ .... INSTRUCTIONS a. This application must be completely filled in by typewriter o~ in in.k and submitted in triplicate to the Building ~ Inspector, with 3 set~ of plans, accurate plat plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets os 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 o 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 1S 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 nome, if a corporation) ...... ........ (Address of applicanf)TM Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises If a~pli'ca~t is a ~orp~ate, signature of duly authorized officer. ................................ ~ ' j/ (F~fme and title of corporate officer) Other Trade's License No ............................................... 1. Location of land on which proposed,work will be done. Mop No.: ........................................ Lo,t No....~....~.~ .............. Street and Number;J,,~~.~4~. ~,~¢¢t~.~,~ ................... x~..~'~.~.. .............. Municipality 2. State existing use and occupancy of ~remises and in~nded use and occupancy of proposed construction: o Ex stng use and occupancy ~t,~ ~,~,,~,~,¢,j ........ ';"; ........ ................................................................................................ b. Intended use and occupancy ................................................................................................................................ 3. Nature of work (check which applicable): New Building :.. ............... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................... Other Work .......... ~i;~')' ............. 4. Estimated Cost ................................ f~.~..~'~.~.~ .......... 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 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 a.lterations or additions: Front .............. :: .................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number af Stories ........................................................ ;. ............................................. ~ .............. 9. Size of lot: Front .................... 1.5.~.~.....~T.;~ .................. Rear ............. ,Z.~..~, ................... Depth ...... ~,~..~.. ................ 10. Date of Purchase ........................................................ Name of Former Owner ..,/~:~.~-/-~kc'....~..~.~. ................................. 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 premise ..~. .......... Addre~ ,.. Phone N~t~,~.~..:..I,~.f... ? Name of Architect .............................................................. Address ................................ Phone No. Name of Contractor r,~,~-~..~-~r~J~..~..~..~ ............. Address ..~,:~ ........... Phone N ........................ 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. ~divi~ual signing contract) a'bow~ named. duly sworn, deposes and says that he is the applicant -(J"'"~4.~' (Contractor, agent, corporate officer, etc.~ of said owner or owners, and rs duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application ore 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. NOT,~RY PUBLIC, 3tale of New 'fork ~qo 52-8~25850, Suffolk Term Expires Msrc. h 30, ~"~-~