The URL can be used to link to this page

Home My WebLink About8013-z FOI~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHGLD, N~. Y, BUILDING PERMIT (THIS PERMIT MU~T BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ~o. ~0~ z ~a,e ......... ~.....~..~ ........ ¥ Permission is hereby granted to/~ / /r3 /~ ^ ......... ............... ,o ........................................ pursuant to application dated ..................... , 19.. , and approved by the Building Inspector. ~'~ Fee $.../...~.: ............. Building Inspector Examined Approved FOR, M~ ~O, TO~HN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICI~ SOUTHOLD, N, ¥. Permit No. Disapproved a/c .................................. ~.~..~ ............ (Building Inspector) ................................ APPLICATION FOR BUILDING PERMIT ~ '~ INSTRUCTIONS~ a. This application must be completely tilled 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 af lot and af buildings on premises, relationship to adjoining premises or public streets or 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 o Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be accupled 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 afferations, 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 inspectorson premises and in, buildings for nec~~;? ~~~inspecti°ns. (Signature of OpDlicant, or name, if aco, rporation) ............. ....... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...... ~.~.~Tf:....: ...... .~..]..~....!..C...!..~.. ....... &f~-f/../.~.~.~l ....... ."..~....//m. .......................................... if applicant is a corporate, signature of duty authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ................................................ ~ /~' Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ......... .~..~.. ....................................................................................................... b. Intended useandoccupancy ..... ~-.~?.¥. ............. '..~..........D...~..6~.......~.~i~n, ...... --~~ .......... 3. Nature of work (check which applicable): New Building.. ................. Addition ....~, ......... Alteration ............... Repair .................. Removal .................. Demolitior~ .................... Other Work ....F~..~..~..f~. .......................... (Description) 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 .................... l-leight ........................ Number of Stories ................................................................................................................. Dimensions of some structure with alterations or additions: Front .................................... Rear ............................ Depth ................................Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ................... , ................ Rear ............................ Depth ........................ lqeight .................... Number of Stories ..................................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Dote of Purchase ......................................................~?Ix~onfip[~ of/.9.Former Owner ........................................................ 11. Zone or use district in which premises ore situated ..../-t. ......... /.~ ........................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 14. f emi {.~..~.. ..... one N . ..~..l..~...~. Name of Architect .............................................................. Address ................................Phone No ....................... Name of Contractor ............................................................ Address ................................ 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 NE~/~Y~)RI~,~/ COUNTY 0~~.'~,.~-... ~ ................................................................................................. being duly sworn, deposes and seys that he is the eppliconl (Name of individual 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 oil statements contained in this application ore true to the best of his knowledge and belief; end tha~ the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this · ...... ........................ (Signature of applic6__n..tY ' JUDITH T. BOKEN