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Home My WebLink About7929-z l~OEM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT CT'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7929 Z Permission is hereby granted to: ,~ Z~ ~ ~ ,~ ~,~ c~' / ~' pursuant to application dated ................................ ..~.~.,~.,~f. ...... ~.~./., 1975 ......... , and approved by the Building Inspector. Fee $.../..~ ............... Building Inspector TOWN OF $OUTHOLD -~/..~ ' - BUILDING DEPARTMENT TOWN CL,..'S OF.C, $OUTHOLD, N.Y. ~/~ ~~, ~ Application No~ ~.~.~. ........ Examined .......................... ~;':~", 19....~... Permit No ..................................... ....................................... z APPLICATION FOR BUILDING PERMIT Date ........................... INSTRUCTIONS a Th~s application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildin- 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 premmes, relationsh,p to adjoining premises or public streets oF areas, and giving a detaded description of layout of property must be drawn on the diagram which is part of th~s 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 permi; shall be kept on the premises available for inspection throughout the work. e No Lluddmg shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupanc} shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment for the issuance of a Building Permit pursuant to th, Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances o. Regulations, for the construction of buddings, additions or alterations, or for removal or demolition, as hereto described The apphcant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and t, admit authorized inspectors on premises and in. buildings for necessary inspections. (Signature of apphcant, or name, if a corporation) . (Address of applicant) State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises ........ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's bcense No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. /~ ------- Other Trade's License Na ............................................... Location of ,and on whichyoposed work wil~,~one. M~p No ....................... (7 ~...~../. ....... Lot Noc~ .~..::..~.....~..~ Street and Number .,~,/r~..-...~.cz.~ .......................................................................................... Municipality Stale existing use and occupancy of premmes and intended use and occupancy of proposed construction' a Ex,s,ting use and occupancy ............. ./..........~...~..~b..'~ .~:/~,) ........ ~/.. '¢' ~"? ~'-/- /..~ / b Intended use and occupancy ........................ ~ ............. ~ ................................................. 3. Nature of work (check which applicable). New Du,ld~ng ........ A~ld,t,on ...... - ....~.. Alteration ........... Repair ................ Removal ............... Demohtlor. .......... Other Work ..... ~. .~..~.~~'~'~ .................. ,-- ~x Z/ (Description) O 4 Estimated Cost ................. ~... .................................... Fee ......... I..x'. ...................................................................... (to be pared on filing th~s application) 5 If dwelhng, number of dwelhng un,ts ..................... Number of dwelhng un,ts on each floor ...................... If garage, number of cars .............................................................................................................................. 6. if business, commercial or m~xed occupancy, specify nature and extent of each b/pe of use .................... 7 D~menslons of ex~stmg structures, if any. Front ........................... Rear ................................ Depth .................... Height ........................ Number of Stones ....................................................................................................... D~mensions of same structure with alterations or additions. Front ................................... Rear ................... Depth ................................ Height ...................... Number of Stories ................................ 8 D~mensions of entire new construction: Front .................................... Rear ............................ Depth .................. Height ................... Number of Stories ....................................................................................................... 9 Smze of lot Front ................................................. Rear .................................. Depth .............................. 10. Dote of Purchase ....................................................... Nome of Former Owner ...................................................... 11. Zone or use distr~ct m which premises are situated ................................................................................... 12 Does proposed construction wolate any zomng law, ordinance or regulation' . ...................................................... 13 W~II lot be regraded ........................... W~II 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 ex~sting or proposed, and red,cate all set-back d~menslons fron property hnes Gwe street and block number or descnpt,an accord,ng to deed, and show street names and ind~cat, whether interior or corner lot S'I-ATE OF NEW Y,~RI~., .¢ ~ S S COUNTY OF .'~~..~f .....~4~/~~.---t... .... ~..-c..er~.~;~,~_~. ...................... be,ng duly sworn, deposes and soys that he ,s the applicon (Name of mdiwdual signing contract0 above named He ~s the ..~G.~/_~ ....................................................................................................................................... (Contractor, agent, corporate officer, etc.) of sa~d owner or owners, and ~s duly authorized to perform or have performed the said work and to make and f~l, this apphcat~on; that all statements contained ~n th~s apphcot,on are true to the best of his knowledge and behef; an~ thaz the work will be performed m the manner set forth m the application filed therewith. Sworn to before me this Notary Public, . ................................................... County ...................................... (Signature of applicant)