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Home My WebLink About8432-z FO]gM NO. ~ TO~N OF SOUTSOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AOTHORIZED) Permission is hereby granted to: Examined Approved TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. APPLICATION FOR BUILDING PERMIT Date..~£~.~.~.~...(.JL'. ...... ~.-~..~. .............. , 19.~...~ .... INSTRUCTIONS a Th~s application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildin~ Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of butldmgs on premises, relationship to adjotning premises or pubhc streets areas, and giwng a detailed description of layout of property must be drawn on the diagram which is part of this apphcation c. The work covered by this apphcat~on may not be commenced before ~ssuance of Budding Permit. d Upon approval of this application, the Building Inspector will ~ssue a Budding Permit to the apphcant. Such permi. 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 Occupanc~ 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 th, Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o 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 cede, and regulations, and t, admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) ........... ...... ........... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ...... .................................................................................................................... Name of owner of premises ..~.1~ ....... ~..%,.~.~'~.~, .......................................................................................... If apphcant is a corporate, s~gnature of duly authorized officer. (Name and t,tle o,/~rate o~ic.e~) Builder's bcense No ...... .~/....~.~.] ............ Plumber's bcense No ................................... I. ............ Electrician's License No ............................................. Other Trade's License No ............................................... ~ n~ 1 Location of land on which proposed work will be done. Map No ..L..~.,~.'-t~. ......... Lot No ...~.~. ............. Street and Number ....'.'.'.'.'.'.'.'.~~~.~ ....... .'~.~ ........................................................ ...~.~?-~..-'~... ...... Municipality 2 State existing use and accupancy of premises and in~,ended use and occupancy of proposed construction' a Exis,ting use and occupancy ....................................................................................................................... b Intended use and occupancy ....~..~.r~.j~. ....................................................................................................... 3. Nature of work (check which apphcable) New Budding .............. Add;tlon ................ Alteration ........... Repair ................. Removal .................. Demoht~or. .......... Other Work ...~...~..q~.l~ ..................... .~1(/~.~.. )~ (Description) 4 Estimated Cost ..... ~.....-. ........................... Fee .................. .~..~.~....-.. .............................................. (to be pa~d on filing th~s application) 5. If dwelhng, number of dwelling umts ..................... Number of dwelhng umts on each floor ...................... If garage, number of cars ............................................................................................................................ 6 If business, commercial or m~xed occupancy, specify nature and extent of each type of use ........................ 7 D~mens~ons of exmtmg structures, ~f any: Front ..................... Rear ................................ Depth ............. Height ........................ Number of Stories ............................................................................................................. D~mensions of same structure w~th alterations or addmons Front .................................. Rear .................... Depth ................................ Height ................ Number of Stories ................................ 8 D~mensions of entire new construction Front ................................. Rear ......................... Depth ............. Height ................... Number of Stories ................................................................................................. 9 S~ze of lot. Front .............................................. Rear ................................... Depth ............... 10. Date of Purchase ................................................. Nome of Former Owner ...................................................... ] I. Zone or use district in which premises are situated .................................................................................. 12 Does proposed construction violate any zoning Iow, ordinance or regulation' .......,~...~.. .......................................... 13 Wdl lot be regraded .......... ~ ...........Will excess fill be removed from premises: ( ) Yes (,X') No 14 Nome of Owner of premises .~¢J~......t(~/~..4'.~.~. .............. Address .%~...~~',.~//~N~e/ne No ...................... Name of Arch,tect .............................................. Address ................................ Phone No ...................... Name of Contractor .~.~f2~..~£~.~/1~. ~,~2. L~'Y~.¢..~.... Address/~,~.~/.~ Phone No. PLOT DIAGRAM Locate clearly and distinctly all buddings, whether ex~stmg or proposed, and red,cate all set-back d~mens~ons fron property hnes Gwe street and block number or description according to deed, and show street names and indicate whether interior or corner lot STATE OF NEW YORK, ~ c c COUNTY OF ...... St~f. alk ....... f° ° ........... J.o.h~..~arr. is.~ ....................................... (Name of individual s,gning contracO above named being duly sworn, deposes and says tho he ,s the apphccn He ,s the ............................................ .O.O~.~C}~. ........................................................... (Contractor, agent, corporate officer, etc ) of sa~d owner or owners, and Is duly authorized to perform or have performed the said work an this apphcat~on; that all statements contained in this apphcahon are true to the best of his knowl, that the work will be performed ,n the manner set forth In the apphcat~on filed therewith J to make andl'fil ~dge and behef;lan Sworn to before me this ....... ....... .................. Notary Public, . ................ :~: ............. .~l~l.f.f..o'l.k County ................... ~..,.~.... ~; ~ (S'gnature of applicant) 'r ' NOf~,~Y PIlBL[C, State of No 52 81~595I1, S,fffoll'~ County r~rm Ex:~res ~la~ 30,