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Home My WebLink About8250-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT LTHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ............................ : .............................. ~~ .~.~..~. .................. ~ ..... : ......................... · ...... pursuant to application doted ........ ~. .......... ~ .............. , ] .... ;., and approved by the Building Inspector. /////'/ o..q'~ / ' ~P O[ LAklB SURYEYTD 'i~1; [, lq/^. ,t^ t L L r: R t:U TC,WO~ U£ 'T6WH OF $OUT~4OLD, SC.~L[ · ~0'- !" V.BN TUYL : SON ·- I-RON PIPE IH = ~ONU/ALHT TOWN OF SOUT.OLD '//a°/Z¥ - OA BUILDING DEPARTMENT X~. ~ TOWN CLERK'S OFFICE ~~~ ~' ~THOLD, N. Y. Application No~~ .............. Di app d / ' ' ' S rove Q C ............................................................................................ INSTRUCTIONS a. This application must be completely filled in by typewriter ox 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. Plat plan showing location of lot and of buildings on premises, relationship tO adjoining premises or public streets or areas, and giving a detailed description of layout afproperty must be drawr~ 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 occupied or used in whole or in part for any p. urpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLiCATiON IS HEREBY MADE to ti~e 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 alterations, or for removal or demolition, as herein described. The applicant agrees to comply with oil applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessaj~ inspections. .................. (Signature of applicant~,;r name; if a~rporation) (,~ddress of applicont~/ State whether applicant is owner, lessee, agent,' architect, engineer, j;A~qeral contractor, el~.itricion, plumber or builder. If ?i~plicanj' is a corp.,e~te, signature c~duly authJfiCized officer. .... (Name and title of corporate ott~cer) /' - Builder's License No ..................................................... Plumber's License No .................................... : ............ Electrician's License No ...... : ...................................... Other Trade's License No ............................................... ~ ~'-~- ~ 1. Location of land on which prolapsed work will be dgne..Map No ........ ~ ............ ~,...: ........ ,~...... Lot N,~t. ..... Street and Number Municipality 2. State existing use and occupancy of premises and/~ende.~d use and occupancy o( proposed construction: b. Intended / / 3. Nature of work (check which apphcob[e): New Buddm§'. ................. Add t~on ,,--..~........~.~,lt, erat~on ................ .,~'./~' -- ~ ~,--~" 0 ~L ~/'/7 (De~iption) 4. ~stimated Cost ....................... 4...~r.~:., ........................ e ..................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number af 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 ........................ Height .................... Number of Stories ..................................................... ~ ............................................................... 9. Size of lot: Front .... ~...~..~Zi,,~/~/ .................. Rear ....... '~.~..~, ................... ,~,,,, ~ ~_ ,2' D. ept/,~.~.. ....... ~,,..~.. ....... 10. Date of Purchase ...... ~..~..Z.~.. .................................. Na~e~*i°f"F~'~mer Owner ....~.~ ........................... ! 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 excess fill be removed from premises: ( ) Yes ~(~ No 14. Name of Owner of premises .................................................... Address ................................ Phone No ....................... Nome of Architect .............................................................. Address ................................ Phone No. ...................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate dearly and distinctly oil 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 ;~RI~7/ ~, ,~ ] ¢ c COUNTY 0 F~,~~. ~'~'~ ................................................................................................ being duly sworn, deposes and soys that he is the applicon~ (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 all statements contained in this application ore true to the best of his kriowledge and belief; and thor the work will be performed in the manner set forth in the application filed therewith. Sworn to befon~me this /'~,m ,~ ,~ ~ ..... o . ....., Nora, Pu~..~~n~ ~...~.:~ ..... ~;.~.;.;;~.~ ................... , JUDITH T. ~OKEN Nota~ publl~, ~ofe of New York