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Home My WebLink About8510-z : (THiS PEI~MI~ Must BE:KEPT ONL'THE PREMISE~ .UNTIL FOLL COMpLETmO~ 0 HE WORK AUTHOR ZED) r ' ' OPer~nJ~on is h~?eby gtantod to= FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Disapproved a/c ........................................... ~~, ......... .............................. .................... APPLICATION FOR BUILDING PERMIT Application No...~.....~..../.....~.. ............. 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 and of buildings on premises, relationship to adjoining premises or public streets al areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which Js part of this applicatib?. 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. ~'~e o'~apl~ I~can,, or name, If/a Jrdfion) ?--' "-' ? (,~ddress or appucant'F ' - State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............._ ............................................................................. ....................................................... Name of owner of premises ....... ,~.~.tg~:'.~,.T..~.~.~ ........ .~.A..~...~..~..~;~.../C). ................................................................ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ........ f~.....~..'... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... /iA ,q '~ (xx : ~..~.....L~...~ ... ~Lot 1. Location of land on which proposed work will be done. Map_No.: ..... No...../..:.....~ ......... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of groposed const,ruction: " // .... " .... / 3. Nature of work (check which applicable): New Building'. ................. Addition ......~.~, ....... A, Iteration ................ Repair .................. Removal .................. Demolition .................... Other Work ....~.....~.,,~ ................... . 4. Estimated Cost .................. ..~....~....,.. ........................... 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 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 .......... /.L~....~ ................................ Rear ......... .'{...~.~.:.~..~. ................ Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 1 1. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 15. Will lot be regraded. ........................... Will excess fill be removed from premises: ( ) Yes ( ) No 1~. Nome of Owner of premises .......................................................................................... Phone ....................... ~ Nome of Architect .............................................................. Address ................................ Phone No ....................... l'~ame of Controctor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locote cleorly ond distinctly o[I buildings, whether existing or proposed, ond indicate oil set-bock dimensions from propcrty lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NE'v~.,~ORI~,/~,/)/~ I c c ................. L~..: ..... ~ .................................. bein~ duly swom, deposes ond soys that he is the applic~m (~ame of individual si~nin~ contracf) obove namod. He is the ............ ('....~.a.~ ........................................................................................................................ (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 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 b~fom me this · ~ ........... Zf. ..... o, ......... .......... , , o,o. .............. ~ (Si~noture o{ oppHcont) JUDITIt T. BOKEN 77