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HomeMy WebLinkAbout8256-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) Ne 8256 Z Permission is hereby granted to: ..~.....~..'...¢..~/.~.~:..~. .......... ~.~..,?..9..~.~.C at premises located at ............... pursuant to application dated .............................. ~.~.~~ ...... .~.., 1~.~., and approved by the Building Inspector. Fee $.J ...................... Building Inspector Approved ....................... ~ ............... <, Permit No .......'; ............................. Disapproved a/c .................... :~ .._..~..,,~ .................. .~ ................................. .................... :.?~.~:;/~l.~../.i~ ........................... ,....., ....... (Building Inspector) TOWN OF SOUTHOLD ,~, ~ .~ BUILDING DEPARTMENT~_~ ~ ~- ~'~ ~, ~. ~.J. TOWN CLERK'S OFFICE ~UTHOLD, N. Y. Application No ................................. APPLICATION FOR BUILDING PERMIT Date ................ /. .............................. , 19.~.x.:,~.,. INSTRUCTIONS a. This application must be completely filled in by typewriter oe in i~k and submitted in triplicate to the Buil~ling 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 street~ 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 oJher 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, buildihg code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (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 .................. ~ ............. ': ........ ~....~. ............ ,..;. .......... t ...... :...~...,; ......................................................... If applicant is a corporate, signature of duly authorized officer. .................. ......... Builder's Lic~se No ..................................................... Plumber's License No ................................................. Electricion's Licenso No ............................................. Oth*r Trodo's Li*enso ~o ............................................... 1. koc~tlon o{ Iond on which proposed work will be don&. ~R~O,:'.:.~...~?~ ................ kot ~o ......................... Street and Number ' ,. ................................................................ ,,, ..r.,,~untc~a"~' 2. State existing use ond occupancy of premises and in~ended use and occuponcy of pra~Osod ~nstr~ctiqn: a. Ex s t nD use and occupancy ................ L....6...~ ......... .Z...:~:...;e...~,~.'...:';.:~../. ......... ;.. :.....'.; ......... ';;..'.. ......... ~:,?~ ........... b. Intended use and occupancy ............. · ............................................. IIIIr) Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolitier~ .................... Other Work ..... :'""4~"'~:'~'"'.;:..~t ............. .-.. " (Desc ril~tlon) 4, Estimated Cost ................... :./....~.~;'.....-~'] ...................... Fee ........ r~.fJ'r.... ' ...................................................................... (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, 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 ............ Z'...;~:..'.?.. ................................ Rear ~ '/' :~ ' ............ /.. ........................... Depth . ./......'. ...................... 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 1 1. Zone or use'district in which premises ore 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. ~..{., ................ " 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 frorn property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. ......... ....: ...... ~ ...... : ........ ~ .................. ;...~:; ............... ;. c ..being duly sworn, deposes and says that he is the applicanl ~-~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 Jn this apblication are true to the best of his knowledge and belief; and tha~ the work will be performed Jn the manner set fo~h in the application filed therewith. Sworn t~ before me this . ..................... ....... ............... ~Si~noture o~ opplic~nt)