The URL can be used to link to this page

Home My WebLink About8486-z FOI/~ NO. 2 TOWN OF $~UTHOLD BUILDING DEpArTMENT TOWN CC~R~'S OFFIC~ SOUTHOLD, ~. Y. BUILDING. pERMIT (THIS' PERMIT MUST :BE KEPT ON THE pREMISES UNTIL ~ULL COMPLETION OF THE WORK AUTHORIZED) ', , - - Perm~ss~en ~ r gronte~] to: Dote. FO~M NO. 1 TOWN O~ $O~THOL~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Disapproved a/c ....... ~...... ............... ,'5- APPLICATION FOR BUILDING PERMIT ..... r ~ ~ Date ...... '~ ...... .~. .................... , 19.../.i.~.... 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 plari showing location of lot and of buildings on premises, relationship to adioining premises or public streets o~ areas, and giving a detailed description of layout ofproperty must be drown 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 Cbunty, 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. , ~ .~/.~ ~ '. ~ ~z,.~.:~'~...'~.... .......... ~ :.. ~..~. ~ ....... ,. ~:.. ~,.,. ,~...<. ,,: ..... , ~::/. .............. (5ignature of applicant, or name, if a ~orf~oration) / (Address of applicant) State whether appl cant~/~)~ssee, agent, architect, engineer, general contractor:, ele~tri.cian, 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 ............................................... y' ~ 1~ Location of land on whic,b-~p~ro~osed work will be done..~_~M_~p N~.: .............. ~. .................... Lot N ........................ Street and Number .....~./¢~..i......'~.~,-.4~¢~ .......~.~.~)...rff..,..~. ................. . .~.:.'..~..~'.~... ..................................... Municipality 2. State existing use and occupancy ofp,~mises~a~d intended ~se and occupancy of proposed construction: a. Exisiting use and occupancy ....~~..~. ......... ~x'.~/~ ................................................................................ b Intended use and occupancy ~ 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alterg,tipn ....... ;:Z .... Repair .................. Removal .................. Demoht,or. .................... Other Work ....... x....~. ~.,~m..~. ....... (Description) (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 alterations ar additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number~_°f Stories ....................................... k'""'~-/~ ................................................. ~,~__,k~ ............ 9. Size of lot: Front ............ .'~...~ ................................... Rear .......... ./..."ff.. ................. ~ ...... Depth .¢,.~..~(..~.. ............... 10. Date of Parchase ~..~-~'.~....f~...~... ...... ~..~...7...,~. ......... Name of Former Owner .~--~¢'.-~Z~./~.~./..~.......Z'..'~-~,2~i~.~;'~....~...~..~'.. 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 fr~m premises: ( j ) ( ) No 14. Narne of Owner of premisesC~..Z.~..../'...~'../..¢.~. ............................. Addres~.'¢~.¢..~..~...77..../..QCz.~'.'~/i~one No.//~f/.~.~..:....~...?. Name of Architect .............................................................. Address ................................ Phone No ....................... Nome of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly alt 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 ~vhether interior or corner lot. STA-[ E OF NEW YORK, [ S S COUNTY OF ................................ ~ ' ................................................................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing controcf) abow~ 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 opplication;'th~t all statements contained in this application are true to the best of his knowledge and belief; and tk, a~ the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this .......... .......... day of .....~ ~. ........... ; ....... , 19.~-~ ~ ~, ~ ~