The URL can be used to link to this page

Home My WebLink About8125-zTOWN OF SOUTHOLD 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 AUTHORIZED) N? 8125 Z Permission is hereby granted to: ............. ~.~.kt~.~...' .......................................... at premises located at ...~.'~..~,.~%0,..~..X~I,...P.~e~..~I~ .............................................. .............................................. ll/.~..S.~d...Ave ........... ~.eeeaAe ....... ~..~. ..................................... pursuant to application dated .......................A~I~.....$ .................. , 19..~.., and approved by the Building Inspector. Fee $..~ ~[.GJ~ .......... Examined ,.. ~.....~ ............. , Approved t' l 5 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No...9.. /....~7..~..- .............. (Building Inspectc~) APPLICATION FOR BUILDING PERMIT ~ INSTRUCTIONS ~ This application must be completely filled in by typewriter o~ in ink and submitted in triplicote to the BujIdingL~. 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 fo 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 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 a~terations, 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. ... & ..................................... : ...................... :.e..~.. .... (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 ......... ~.)....~..~./...A...J.......~..;.....~...L~/~.......~...~,. ?..(:~ ............................................................................ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. t~ ~- Plumber's License No ................................................. Electrician's License No ............................................. ' Other Trade's License No ............................................... Me No 1. Location of land on which p~osed walk will be done. p .: .......7.~ ............. , .......... N . .., ..................... 'c ', u Street and Number ........ ~%c~:.~-~ ........... ~~ ........... ~~~ ...................... MunicipaliN State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ............. ~.~-~.~..~.~...,..~..,.~...'.'.'.'.'.'.'.'.~..~4/ / b. Intended use and occupancy .................. (~. ........... ~!iii. ~.! ~~.'i~ii ii ii ii iiii iii iii ii 3. Nature of work (check which applicable): New Building~. ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolitior. .................... Other Work ......~..C.,...~::.~.~.~....~..,~ ............... /// (Desc ril:~j6n) 4. Estimated Cast ............................................................ 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 .................... 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 ........................ I-[eight .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 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. 'Will lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises Jff~..~.'~..~/..~......J~.~z'/..~...o....~...~.. ........... Address ................................ Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Nome 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 NEW~'OFJK~, COUNTY OF (Name of individue above named. He is the .................... ~.~. signing contract) .being duly sworn, deposes and says that he is the applicanl (Contractor, agent, corporate officer, etc.) of said owner or owners, and is du.[y-authorized to perform or have performed the said work and to make and file this application; that oil statements contained in this applicetion are true to the best of his knowledge and belief; and that the work will be performed in the m'anner set forth in the application file~Pt+tjJrewith. . Sworn to before me this ~-, ,-, .-- // / / ......... da of .T. ,, ........ -- (~,~ /~ ~ ~ ~ .(/~ (Signature of applicant)