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Home My WebLink About9601-z TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No .... .~.. ................ .~ o. This application must be completely filled in by typewriter or' in ink and submitted in triplicate to the Building Inspector, with 3 set~ of plons, accurate plot plan to s~ale. Fee according to schedule, b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining prem ses or public streets areas, and giving o detailed description of layout ofproperty must be drawn on the diagram which is port 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. to the Building Department for the issuance of a Building Permit pursuant to the APPLICATION IS HEREBY MADE Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicab e Laws, Ord nonces or Regulations, for the construction of buildings, additions or alterations, or for removal or demo t on, os herein described. The applicant agrees to comply with all applicable laws, ordinances building code, housing code, and regulations, and to admit author zed nspectors on premises and in, buildings for necessary inspections. ............... (S'gi:~aturpf applicant, or name, if a corpora~i~'i ....... .......... ............................. '~" '~' (Address of appli~n'f~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder,k~g ................. ............................................................ , ......................................... .. Name of owner of premises ..~:~~/--~z,//d~...~.....~.~'......~.~.~..~~:~'~'~ .................. '..' ..... 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 ............................................. Location of land on w.~,hich proposed work will be done. Map No '/./"~..~.~...'~...~.~. Lot No Street and Number ~.~.~.~.....¢~....~.~.~.~5. .......................................................................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy b. Intended use and occupancy ......... .~.?&...~....x~..,~..~ ...................... SOUTHOI..~, N~ ¥. BUILDING ~PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK, AUTHORIZEO) No. 9601 Z Permission is hereby granted to: tA(~..<:~....~,....<bJ...Z;~.~.<~':'. ....... ..xC.' ~.r~.~. ........ to .................................................... ~r ................. I ................................................................ at prem,ses ,ocat'ea at ....~. ............ .;x.../..~....~ .... -x .............................. '~' ............................................ // pursuant to application dated ................................. .~....~.. ............. , 19.r2..7, and approved by the Building Inspector, F ...;..Z ee $ .................. 3. No~ure at'work (check which applicable): New Building'. ....... Addition .................. Alteration ................ Repair .................. Removal .................. Demolitior. .................... Other Work ................................................... (Description) 4. Estimated Cost ......~....,(~.~..--~?Z~...~'../. .............................. Fee (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 ...~f~, .................... Depth ~ ............ Height ....;~T~..z ........... Number of Stories ...... ~ ........................................................................................... Dimensions or'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 ../.;2'.~¢,-/.,¢..~.,~/..~.~..~.~. ............... Rear .......................... 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 1 1. Zone or use district in which premises ore situated ...~.~¢..~.~..:'~..44.4~....7~/..~..zT.......~...r ...................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ...~...~. ............................................... 13. Will Jot be regroded. ........................... Will excess fi. Il be removed from premises: ( ) Yes ()4~ No 14. Nome of Owner of premises ...~..:.'~.~...¢.....~.:/..¢...~¢.?.~..--" Address .~~¢.~.... Phone No ....................... Nome of Architect ............................................................. Address ................................ Phone No ....................... Nome of Contractor ..... ,,~..~.~..Z~.. ...................................... Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions frore proporty 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 YORK, t c c COUNTY OF ..... ~ ..................... ~' ~'~' ~ ,/~ ......................... ..~.~.¢.~...~.....~~. ............. being duly sworn, deposes and says that he is the applicon, (Name of individual signing contract) above named. hie is the ........... ..~...~-.~.~.~tm-.....~EC¢.~'..~...-~(~:;i-- '~¢~ ;"> .......~...~....~.f ................................................................... (Contractor, agent, corpor e of ic r, c.) 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 are true to the best of his knowledge and belief; and thor the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ~',~ . /~ ..~..~~ ........................ dayof ............................................ ,,9 ........ ~~ Notary Public, . ................................................... County ........................... (Signature of applicant)