The URL can be used to link to this page

Home My WebLink About7925-z FORI~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~.EMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) N? 7925 Z Permission is hereby granted to: ..lt~a~t ~ ..~r~.t~., ...................................... ............ ~. ~ ~l~e.r. LX..~.;~..a. ............................. at premises located at .~JD;n.~l~..A~e..JL.~r. esc.e~t..A~.a ............................................................ .............................................................. ~.~....z.~..z.~ ................................................................ pursuant to application dated .............................l~...~......!.~.. ............ , 19...~.~., and approved by the Building Inspector. Fee $...~J~aJ~ ......... Building Inspector FO~M NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE proved ..................................... ,e,m t No .......... D,sapproved a/c ............................................................................ APPLICATION FOR BUILDING PE~.MIT / INSTRUCTIONS a. Th,s apphcation must be completely filled ~n by typewriter or in ink and submitted in triplicate to the Buildi~ Inspector, w~th 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 streets. areas, and g~ving a detailed description of layout ofproperty must be drawn on the diagram which is part of th~s applicatio c. The work covered by this apphcotion may not be commenced before ~ssuance of Building Permit d Upon approval of this application, the Building Inspector w~ll issue a Budding Permit to the apphcant Such perr, 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 Occupan, shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the fssuance of a Building Permit pursuant to tl Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe The apphcant agrees to comply with oil applicable laws, ordinances, building code, housing code, and regulations, and admit aulhorized 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 build, If applicant ~s a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's L~cense No .................................................... Plumber's L~cense No ................................................. Electrician's License No ............................................ Other Trade's L~cense Na ............................................... 1StreetL°cat'°nand°f landNumberOn wh,ch~..~.~~...~roposed ork wil be done M~p No ...... :~[;::~j~~/~ ~.~Lot No Municipali~ 2 State existing use and occupancy of praises and in~ended use and occupancy of propased construction' use occ. an ............. ...... ......... ................ ................ 3. Nature of work (check which applicable). New Building...... ............ 0x Addition .................. Alteration ............. Repair ................Removal ................ Demolmor .............. Other Work .............................................. *r~ ~ (Description) 4. Estimated Cost ............................. : ........................... Fee ..~.../,4'...........-~-. ................................................................ (to be po~d on filing th~s apphcat~on) 5 If dwelling, number of dwelling units ........................... Number of dwelhng units on each floor .......................... If garage, number of cars ............................................................................................................. ~ ............... 6. If business, commercial or m~xed occupancy, specify nature and extent of each type of use ~...--;~.....~.... 7 Dimensions of ex~stmg structures, if any: Front ........................... Rear ................................ Depth ...........1~ .. Height ........................ Number of Stories ............................................................................................................... D~mensions 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 Stones .............................................................................................. 9. S~ze of Iot Front ..................................................... Rear ....................................... Depth ............................. 10 Da, e of Purchase ................................................... ,~,~a~me~ F~orr~er Owner ....................................................... 1 1 Zone or use district ~n which premises are situated .x 4 ....... ~...-m-.....: .......................... ~..~) ................................... 12 Does proposed construction violate any zoning law, ordinance or regulation ..... <..:....¥'. ........................................ 13 WHI lot be regraded ............~ ..... Will e._~.~..~ss fill bM removed from premises:/l( ) Yes ( ) No Owner of premises ..~../~:~..~~ress ..... ..~....,~.......~....: ..... Phone No ..................... 14 Name of Name of Architect ..................~ ............................. Address ................................ Phone No ..................... Name of Contractor ............. ~~ .................. Address ................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ex=sting or proposed, and red,cate all set-back d~mens~ons fror property hnes Gwe street and block number or description according to deed, and show street names and ind~cat whether interior or corner lot · being duly sworn, deposes and says that he ~s the apphcar above named ~~~ ~~4~._ He ,s the ........................................... .......................................................... of sa~d owner or owners, and is duly authorized ta perform or have performed the sa~d work and to make and f~l this application; that all statements contained in th~s apphcat~on are true to the best of his knowledge and behef; an thor the work will be performed in the manner set forth in the apphcat~on filed therewith. Sworn before th~s me ,,~,~..~. ~K___,~.to ................... L?. ~day of ........... Nota ryPubl,c,. .............. /' ~~ County (Signature of applicant)