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HomeMy WebLinkAbout9257-z FORI~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TO~VN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT CrHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9257 Z Permission is hereby tO at premises locate~ at ..................................................................... pursuant to application dared , ....... }.~....~. ..... ..,~' ,~; ........ , 19.....Z,/ and approved by~ the Building Inspector. TOWN OF $O~THOLD BUILDING DEPARTMENT TOWN CL.ERK'S OFFICE SOUTHOL.D, N. Y. ....... ..................................... Disapproved ~'"~' '"': ~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 showing Iocat,on of Jot and of buddings on premises, relationship to adjo,ning premises or public streets areas, and giving a detailed description of layout ofproperty must be drawn on the d,agram which ,s part of this applicatio c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this apphcation, the Building Inspector will issue a Building Permit to the applicant. Such pern- shall be kept on the premises available for inspection throughout the work. e No bu,ldmg 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 issuance of a Building Permit pursuant to ti 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 applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in buildings for necesscLry inspections. (Signature of applicant, or name, if a corporation) ........... ............................ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electnctan, plumber or budde Name of owner of premises ....~ ......... ~~.. ........................................................................ If apphcant 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 Trade's License No ............................................... Locahon of land on which pr. opose~L.work wiJLI be do~e..Map No ....................... .._z.. - Lot No ..... ~ ............. Street and Number ............ ...~/'.~.. ~...~.....&~...~ ........... ~; ........... ~~-~. ..................... Municipality State ex,sting use and occupancy of preT~.~ded use and occupancy of proposed construction' a Exisiting use and occupancy ........... ~ ....... : ............. ~ ............ ._. .................................................................. b Intended use and occupancy .............. . .,~........c~: ~...~..~ .: ............................................................ 3. Nature of work (check which apphcable) New Bu~dmg ............... Addition ......~ .......Alteration ~ ...... Repair ............... Removal .................. Demolmor ............. Other Work ........................................... ~ :~ (Description) 4 Estimated Cost .......................................................... Fee /i"~"' ~ (to be pa~d on filing th~s application) 5. If dwelhng, number of dwelhng units ..... ~ ...... Number of dwelling umts 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 D~mens~ons of ex~stmg structures, if any Front ...................... Rear ................................ Depth ................... Height ........................ Number of Stones ....................................................................................................... D~mens~ons of same structure with alterations or addmons: Front'. ................................... Rear ....................... Depth ............................... Height ................... Number of Stones ............................. 8 D,mens,ons of entire new construction: Front .... ~...~... .................... Rear ...... ~...~.... ............ Depth ...~. ~ ........ Height ................ Number of Stones ..... ~.~.~ ................................................................................... 9 S~ze of lot' Front ................................................. Rear ..................................... Depth ............................ f For ~ er ~ "~:~ '~'~ ~ ' 10. Date of Purchase ................................................... ~Name,~' rr~er 'own .......: ........ .':~.:...' ........ ;. ...... ; ............. t/ , 11. Zone or use d,strict ,n wh,ch prem,ses are situated .~l; .... ~: ............................................................... 12 Does proposed construction wolate any zoning law, ordinance or regulation ............. ..Z~.......C/... ............................. 13 W,II lot be regraded ....... "~/' "r'0~'/'~/',/. I 2'e/.~/,Z/~ .Will exc. e.~s,f,Jl .b,if,~.~, removed from. (~/)~l/p-rem~ses: ( ) Yes ( ) No 14 Name of Owner of premises ~.~...../..:.'~.../~'~ddress .... ..N'~.~ ........... Phone No ..................... Name of Architect ................................. Address Phone No ..................... Nome of Contractor .~'/~.....~. ~.~ .......... Address iiiii~iiiiiiiii Phone No ..................... PL/DT DIAGRAM Loco~e clearly and d~stmctly all buildings, whether ex~stmg or proposed, and indicate all set-back d~mens~ons fro~ property hnes Gwe street and block number or description according to deed, and show street names and md~ca~ whether interior or corner lot S'~-^~E OF ~EW ~¢,~,~, z .,f ~s s counTY o~ ...~~..r _-,'"2... ~ , ........................ /ll!.~...~....~... ....... be,ng duly sworn, deposes and says that he Is the appho (Name('o)r/'m'"diwdual s~gnmg contract)/ He ~s the .......................... ..~x::::~..~....~.....~.~ ................................................................................................... (Contractor, agent, corporate officer, etc ) of said owner or owners, and ~s duly authorized to perform or have performed the sa~d work and to make and th~s apphcat~on, that all statements contained m th~s apphcat~on are true to the best of his knowledge and behef, , tha~ the work wdl be performed m the manner set forth m the apphcation filed therewith Sworn to~,~g~e me th,s ~ .~, ............ ........ .... ~oto~ ~bl,e,. .............. ~..~ // .'... Co,n~r ................. IS~;;o~C;;;';Z~"~;~;p~ .......