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Home My WebLink About9220-z FOB~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ............... ~....C~...~..., 19...?....7 Approved .................... ~.c ..... ~...., 19.~.~. Permit No .... ..~....~......~....?.....~.. D~sapproved a/c ............................................................................................ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildi~ Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan show~ng location of Iot ond of buddings on premises, relationship to adjoining premises or public streets, areas, and gwing a detailed descrlphon of layout ofproperty must be drawn on the diagram which is part of this applicatiot c. The work covered by this apphcation may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector wdl ~ssue a Building Permit to the applicant. Such perm shall be kept on the premises available for inspection throughout the work. e. No budding 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 Department for the issuance of a Building Permit pursuant to th 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 all applicable laws, ordinances, building cede, housing code, and regulations, and or ......."i ....... 'g ' Yt~' .......................................................... ppl/i'c6nt, nome, if a corpor~;i~) '" (Address of oppliconf) State whether ~p~hc*nt is owner, lessee, .~ent, ~rchitect, engineer, ~enerol electric~on, plumber or builde Name of owner of premises .... If ~nt,i~'~ co~omte, signature, of dulg out~orized officer. ............... ; i/ii;i ......... Builder's Lic~se No ..................................................... Plumber's bcense No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... Location of land on whk:h~,~oposed~_, -w°rk will be done. M~.p No ...................... : .......... Lot No ....................... Street and Numh~r T"(/'~ Store ex~st~n9 use ~nd occupenc~ of premises end intended use ~nd occupenc~ of proposed construchon: a Exisiting use and occupancy b Intended use and occupancy 3. Nature of work (check which applicable) New Building .......... Addition ..~....... ....... Alteration ................ Repair ................. Removal ................. Demolmor. ................ Other Work ................................................... ~ .~"'000 ~' (Description) 4 Estimated Cost ...'~..~ ................................................... Fee ...ff.. ~ii.' ........................................................................... (to be pa~d on filing th~s application) 5 If dwelling, number of dwelling umts ........................... Number of dwelling 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 Dimens,ons of ex,st,rig structures, if any. Front ...... ............... Rear ...................... Depth .?¢:.....~..' .......... Height .... !.~.' ............. Number of Stones ...... i .................................. :::.~ ............................................ ; ................ D,rnensio? ~:)f same structure with altera/t,ons or add,t,ons. Front .... .~..,~. .......................... Rear ....~..l~ ................ Depth ...... r'~L~'~..t. ................Height .(..~. ................ Number of Stories ..... ./ ........................ 8 D~menstons of entire new construcbon: Front ................. , ................ Rear ............................ Depth ..................... Height .................. h~umb~er of Stories ............................................................................................. ; .................. 9 Size of lot Front .... ..: .......................................... Rear ........................................ Depth ./. .....2 .................... 10. Date of Purchase .................................................... Name of Former Owner ...... .~ ............................................... 11. Zone or use distnct in which premmes are situated ................................................................................................ 12 Does proposed construchon wolote any zoning law, ordinance or regulation' .......- ................................................ 13 Will lot be regraded ........................... Will excess fill be removed from premises: ( ) Yes ~Y~) No 14. Name of Owner of prem,ses .~.~.t-]..~.....~Z. ft~...~.~,l~.. ............. Address .~."{ ~//f1~//~/'(-5 /~ t//~. Phone No. · ........................ Name of Architect ................. J~)6~1~')'/.1 ~11~/("~ ...................... Address ................................ ~7 %~/~h/ Phon~ No ...................... Name of aaress .... ,one PLOT DIAGRAM Locate clearly and dmtmctly all buildings, whether ex=sting or proposed, and red,cate all set-back dimensions fror property hnes Gwe street and block number or descnphon according to deed, and show street names and indicat whether interior or corner lot ETATE OF N COUNTY OF :W YORK, ~ .......................... ~SS ................................................................................. being duly sworn, deposes and says that he ~s the applicor (Name of indiwdual s~gnmg contract) He ~s the ..................................................................................................................................... (Contractor, agent, corporate officer, etc ) of so~d owner or owners, and ~s duly authorized to perform or have performed the said work and to make and fil th~s applicahon; that all statements contained ~n this apphcation are true to the best of h~s knowledge and belief; an tha~ the work wdl be performed in the manner set forth m the application filed therf~jth. Sworn to before me this . / ............. ~.....~ '~ ~-~day ojf ..... i~. ......................... , 19r~ (Signature of al~licant) No B2-4522026 - S,~Wk County ~ornrnilsion Expires M"a~ch 30,