HomeMy WebLinkAbout7737-Z ll'OR,~ NO. ~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTI~FULL
COMPLETION OF THE WORK AUTHORIZED)
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Permission is hereby granted to:
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to~. :-i.-.;. ~: .~...::L....a.:~; Li. ~.~. ~ .n... ~...~.~.~.~....a...~.~e ........... r..a..t..i. ,o.,~ s.....o.~...e...x.-~..s..t...i,~ ~...d.~:.e. ~.~ ~..n.~ ....................
at premises located at ............................................................................................................../.!Lu........
/ ~".Z'¢h ~. , ]9..~.'~..., and approved by the
pursuant to application dayed .......................................................
Building Inspector.
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........ '/'"ir'"'"';" ............... ~"~' .......... I ........................
Building Inspector(
F~ NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
~OUTHOLD, N. Y.
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
a. This application must be completely filled in by typewriter or 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 lot and of buildings on premises, relationship to adjoining premises or public streets or
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 other applicable Laws, Ordinances or
Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, os 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.
.... ..........................................
(Signature of applicant, ~r name, if a corporation)
....
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Nome o{ owner of premises ..........................................................................................
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 .............................................
Other Trode's License No ............................................... AA o ~(' ~X,
1. Location of land on which prop_ose~.worlg~il_l be done~M_ap N .: .~, .................... ~,*t:.....~.~;Zt4~_(~ ..:.; ...................
Street and Number ....... ..'~.....7....-~.... ....... ' ~' "''~...~....~ ....... ~ ........ .~.~.../?.~ ...................
Municipality
2. State existing use and occupancy of p~mises~ intended use and occupancy of proposed construction:
o. Exisiting use and occupancy ..... ~..1~..' - .:......./. ........... ~ .....................................................................
b. ntended use and occupancy ..................................... :..'~....~.~...~....~..C4<~-~.. .............................................
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3. Nature of work (check which applicable): New Building.. ................. Addition ........ .,'~... ..... Alteration .../~. ..........
Repair .................. Removal .................. Demolitior .................... Other Work .....................................................
(Description)
4. Estimated Cost ................ ..~.~...0...0...0...~ .................... Fee
(to be paid on filing this applicotion)
5. If dwelling, number of dwelling units ........ ..~..~ ....... Number of dwelling units on each floor ............................
If garage, number of cots .............................................................................................................................................
6. If business, commercial or mixed occuponcy, specify noture 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 olterations 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 ........................................................ Rear .......................................... Depth ................................
]0. Dote of Purchase ........................................................ ~ome of Former Owner ........................................................
13. Will lot be regraded ...... "~'"'?"ll~,.~£1,1,/zWill exce,~ filbbe removed/~/~.'/rr"~-fr'e~n'a~'ltfit~ ( ) Yes (/~ No
14.
Nome
of
Owner
of
premises .....~.L.~..~...[.:....(,.~ ...... Address~.~..~ ......... Phone No .......................
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Nome of Architect ..............................................................Address ................................Phone No .......................
Name of Contractor ........... ~ .......................... Address ................................Phone No .......................
PLOT DIAGRAM
Locate clearly 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 NEV'/ Y.I~RI~,/,./~' . [ ¢ ¢
COUNTY OF ..~-.~'~"~
................................................................................................. being duly sworn, deposes ond soys thor he is the opplicam
(Name of individuol signing controc~)
above named.
He is the .................................................................................................................................................................................
{Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duty 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
that the work will be performed in the manner set forth in the application filed therewith.
.......
Notory Public,~..~..~'...;.~~,nfy ................. (Signo'ture of/'op~ii:~'r~¥)' .............................