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Home My WebLink About8548-z BUILDIHG PERMIT (THIS PERMIT MuST BE KEPT, COMPLETION OF THE ORK ~ N°. 8548 Permission is hereby §rorited tO at premises Approved ........................................ , TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ,erm,t ........ Disapproved a/c .......................... ~.. ~.~Z'~ ......................................... ( ' ' g p or) f APPLICATION FOR BUILDING PERMIT ~ '~'3 Dote ................................................ , ] 9 ............ INSTRUCTIONS a. This application must be completely filled in by typewriter orJ 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 or areas, and giving a detailed description of layout of property 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, buildin, g-~ode, housing_c, ode, and regulations, and to admit authorized inspectors on premises and ir~ buildings for necessary l~,Jbections (Signa~ of applicgnt, or nome, if a corporation) (Address of applicant) State whether applicant is ownpr~, lessee, agent, arch!tact, engineer, general contractor, electrician, plumber or builder. ', -' t ..... ",', ~ \ I ,'Ir ///./ Name of owner of premises ...~.:.>/. .......................................................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of cor~'~,~ffjc~r) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... ~)~i ~, 1. Location of land on which ~pased,w~¢k wild-dane; Mop No. .~.~ ..... ~ ....... Lot No ......................... Street and Number ................................................................................................................................................... 2~ State existing use and occupancy of p~.~gr~d~n~e~ded use and>ccupancy of proposed constrMu~tniioCin~ality a. Exisiting use and occupancy ............. ~:~:;.z.~z~....~zc~,:..:~4~z.,c..C~..Z>. ....................................................... b. Intended use and occupancy ........................................ ~..... ................... ~ .................................................... 3. Nature of work (check which applicable): New Building.. ................. Addition '"'~:'"~m-~--- Alteration ............... Repair .................. Removal .................. Demolition ................... ;_,O. tber Work ..~'--.' .......... 1 ................... ' ........ ~ LZJ v (Description) 4. Estimated Cost ............................................................ Fee .......................................................................................... ~/~..,.~_ (to be paid on filing this application) 5. ff dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ I ~ 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 ........................ kteight .................... Number of Stories ..................................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ..................................................... ?~,~qBm~'.q.F~rmer Owner ........................................................ 11. Zone or use district in which premises are situated ................................................. ~¢~.¥) ........................................... 12. Does proposed constructio~i~)~la/te)any zoning law, ordinance or regulation: ............................................ : ........... 13. Will lot be regraded . ............ .~. ............ Wi.l/ ¢×d~s, fill be removed from,l~'"emises: f~_.) Yes ( ) No 14. Name of Owner of premises ..~. .............................................. Address ...........-- ...... % .............. Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... N~me of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly end distinctly all buildings, whether existing or proposed, end indicate oil set-back dimensions from property lines. Give street end block number or descrip~-~ion according to deed, end show street names and indicate whether interior or corner lot. '"~ z~ ?¥ STATE OF N~ / S c- ....... .................. ~/,/../:........:.; ................................................... being duly sworn, deposes and soys that he is the applicam (i'~md.~Cindividual 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 application; that all statements contained in this applicotion are true to the best of his knowledge and belief; and that the work will be performed in the manner set foffh in the applicatip~-filed therewith. Sworn to b~e me this 7': ....... :':'7" " ~,~;'~ .-~ (Signature of applicant)