The URL can be used to link to this page

Home My WebLink About8676-z MUST BE KEPT ON THE PI~SES UNTIL FULL OF ~ WORK AUTHOP. IZEg~ $676 Examined pp,icotion .o. 7 API'UCATION FO~'BUILDING PERMIT ......... ...................... INSTRUCTIONS a. This application must be completely filled in by typewriter oe in ink and submitted in triplicate to the Building Inspector, with 3 se~ 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 ofpraperty must be drawn on the diagram which is part of this aPPlication. c. The work covered by this application may na~ be commenced before issuance of Building Permit. cl. 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 s}~ll 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. ........... (~'~;a'~'~f"~ppl~ii~;i;"~r name, if a corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, 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 Liconse No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1. Location of land on which p_mposed work will I~e done. Map ,No.:,.-~,.-~, ................. , ............ LatoNa ......................... Street and Number ......... ..~.,~.~..~..~..~....~...~. ........ .,~.....~...~....~...~.....~/./..~..~.......~.....~.~...o..'~.. .............. ~.Z.d'..~,.~..v.£ ............ b/ x Mur~'cipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ................................................................................................................................ b. Intended use and occupancy ................ ; .......... : . .~, .~.~,,~../,~,, .~../2,~.,7 3. Nature of work (check which applicable): New Building.. ................. Addition .. ~ ........ Alteration .............. Repair ................. Removal .................. Demolition .................... Other Work .................................................. (Description) 4. Estimated Cost ..........................................................Fee ......4.?...~..~ .................................................................. (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 ...... ..~..;.....~?... J 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 ........... .J. ........................................................................................................ 9. Size of tot: Front ........................................................ Rear .......................................... Depth ............................... 10. Dote of Purchase ........................................................Name of Former Owney ........................................................ 11. Zone or use district in which premises are situated .......... .~.c..%.:~,c~t.J/Z.J.i3,..) ......................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ...................................................... 13. Will lot be regraded. .......... [/~,)....O... ....... Will excess fil be removed from premises: ( ) Yes ( ~ 14. Name of Owner of prem,ses ..... ,..~-.r.G.~.~..J.....~..c...~..C,.~..~ Address ............................... Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor '"'x/'--~" ........ 'd"o'/~'/~'//'Cc'~'-~f":C6~ddress ................................ 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 NEW y.4~K, ....~ ,~ ,~ ~ S S ..~.:,'..~;i;~.~/....~'/~......~;;,. ................. being duly sworn, deposes and says that ,he is the applicant ' ........................... .............................. of said owner or owners, and is duly authorized to perform or have performed the said work andi to ~ke and file this application; that all statements contained in this application are true to the best of his knowledge and belief; end thor the work will be performed in the manner set fo~h in the application filed therewith. : Sworn to before me this .......... of ..... ou. ..... Nota~ Public,. .................... "...~~ ~ .... ~ ~..'~.~.~. D ., "-~ ...... / .............. . ~o. 52-8125850; $~o1~ ~m Expir~ ~