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Home My WebLink About8000-z FOR~I NO. ~' TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) N? SO00 Z Permission is hereby granted to: fL~w J.~r"~'"c~',~'" f;~.?rm'e"~:~o'"E ~'~e-----A'/~ d.*~a~'iey-'&ould ......... · ;:.~ ~:r ,~ ~..,~: ~ ,~ c k. ................................................ to .. :~.; ~.~ ~ 4~.. 4',e ~.I.~ :i.~. · C. ~t~.:~ ~,.. :~ ~.~! '...~ ~c.>~ ........................................................................................ at premises located at .....]~a.~'..~Otm~.....~,o.~..~~- ................................................................................ ......................................................... &e'~ .!.~e...Re~ ct. ......... ~:~e}~.~ g .~.....t~. ,.Y.., ............................... pursuant to application dated .................... ~.~.....~, ................... , 19.~.., and approved by the Building Inspector. Fee $..I.~5...(d, ........... TOWN OF $OUTNOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. I. Examined .... ~ /~ , 19.~.~ ~proved ~[]~'"'/'~"'", 19Z~..~ Permit No ~0 ~ ................ ............................ ~U~TIO~ ~OR 8~1~1~ ~R~IT Date Application No. ~ ................ INSTRUCTIONS a Th s 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 o~ areas, and giving a detailed description of layout ofproperty 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 pert for any purpose whatever until a Certificate of Occupadcy 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 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. & ~. (Signature of applicapt, or name, iii a cg[poration) ............. (Address of applicant) Sta~v~t 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 License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License Na ............................................... 1. Location of land on wb~ prj//~osed~6~.l~ill be done. Map No.: ........................................ L~. .... Street and Number .zr/J-"~'/~ ~f~ '~ ............... ; ............................................................................... ~-i ....... ..................... J~'i'l~i~'-' 2. State existing use and occupancy of premises and intend, ed u~e and~o~ccupancy of proposed construction: a. Exisiting use and occupancy ........................................................................ b. Intended use and occupancy .............................................. 3. Nature of work (check which applicable): New Building'. ................. Addition .............. .../.Altera, tJon ................. Repair .................. Removal .................. Demolition .................... Other Work ............pcvrr. v~_..:r.z;j ................ .... ' (De~'%Iption) 4. Estimated Cost ......................... ../~.:~L~ ................ 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 .................... HeJght ........................ 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,Stqries ..................................................................................................................... 9. Size of lot: Front ...................... j~.~ ........................... Rear ................ $~.Q .................. Depth ...... ~D.~..~.~. ..... 10. Date of Purchase ........................................................ Nome of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. WHI lot be regraded . ............. 14. Name of Owner of premise~..~ Address ~t"r-~-- ......... Phone No. '~'~'~'~'g'~l ame of Architect r res P N ' . ............................................................. Add s ................................ hone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... ~ ~ PLOT DIAGRAM ~ ~' kacate clearly and distinctly all buildings, wh~ther existing or proposed, and indicate all set-~ck dimensions from ~%operty lines. Give street and block nu~e.~.,~%r desc[iptlon according to deed, and show street names and indicate ~hether interior or corner lot. ......................... ~..~_.~.~ ............... ~...:'. .......................................... being duly sworn, deposes and says that he is the applicam (Name of individual signing contract) He is the ................................................................................................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the s~Jd work and to ~hJs application; that all statements contained in this application are true to the best of his knowledge and belief; and tha~ the work will be performed in the manner set fo~h in the application filed therewith.