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Home My WebLink About7784-z FOBM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: .... ~~...~~~ ~ ~...-z...z.¢~.~.~..~/~...~ ~_. f;;~;;";;;~2'; ........ ~'X'"";51"~iiiiii~ ........... : ...................... :'~":~ ............ Building Inspector. Building Inspector FOBM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ...................... , 19. ....... Approved ........................................ , l~ ........ Permit No .... : ..... Disapproved a/c ........ :~ ............ "7~ ................. ' ................................ {Building Insp~tor) Applicotion NO...Z.z .~....~.... ........ APPLICATION FOR BUILDING PERMIT Date .....~........~....~...R./.J~. ................... , 19...'~...'~.....~-. INSTRUCTIONS a. This 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 tot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving o detailed description of layout ofproperty must be drawn on the diagram which Js 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 $outhold, 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. ................ .................................. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................. ........................................................................................................................................................ Name of owner of prem ses ............................................................................................................................................... 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 ........ ..~.........~T~. .................. Other Trode's License No ............................................... Location of land on whichproposed work will be done. Map No.: ........................................Lot No ......................... Street and Number ............. 7..~......, ............... .~..~/..(~ ......... ~.~..~....../~.. ........ ~......./.....~,,~1..~..,~.~.....~.....~. ............ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: O. JExisiting use and occupancy ....~...~...~...~...~..~....~.. ~ .............................................................. b. Intended use and occupancy ................... .//. ............................ 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ............... Repair .................. Removal .................. Demolitior ..................... Other Work .......... ...~-. ~.~....f~....~...E'_. .................... ~il ~,,~ ~.¢~ (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 ............................................................................................................................................. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ Dimensions of existing structures, Jf 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 ........................ Height .................... Number of Stories ..................................................................................................................... 9. Size of lot: Front ............ ~...O..~. ................................... Rear ............ ./...~.....~.. .................. Depth ....../..,~.....?...:...~'... ...... 10. Date of Purchase ...... ~..~...../~.....~-~......./.~...~...O. ................ Name of Former Owner ....../~...:....~..~...C~.../.r..~.~....~'. ........... 1 1. 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~¢xces_s,(ill be removed frompremis~:,.( ) Yes (~')_1~ · IA. ~'~ame or uwner or premises .................................................... /~oaress ................................ o e ~'~ ................ Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate cleorly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fram property lines. Give street and block number or description according to deed, and show street nomes ond indicate whether interior or corner Iot~ STATE OF NEW YORI~, w (~c COUNTY OF .~..,,..,~/~¢.¢~. ......... f'"'"' ........................ ~~.~.~,~......~.....:..~...Z~/~V:..~.~ing duly sworn, deposes and says that he is the applicant (Name ot~/irfd'~i'd'Qal signing contracu above named. He is the ....................................................... ~:~.~c~--~"~" .................................................................................................. (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 all statements contained in this application are true to the best of his knowledge and belief; and ti,at the work will be performed in the manner set forth in--the application filed therewith. Sworn to before me this /~ ? ...... ..............................