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Home My WebLink About9272-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, Iq. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? Z Permission is hereby granted to: ............ ~t aho~p~e .............................................. ~;,~ - ~,~ pursuan~ to application dated ........................ ~T;L!33~...1 .................. , 19~.~...., and approved by the Building Inspector. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. rm,t No ...... Disapproved a/c ............................................................................................ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter o~ 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 location of lot and of buildings on premises, relationship to adjoining premises or public streets, areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is 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 application, the Building Inspector will issue a Budding Permit to the applicant. Such perm 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 Occupant 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 applicant 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 applicant, or name, if a corporation) .................... ................................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electriczan, plumber or builde~ ............................................... ............................................................................................................ No~e of ow~e~ of p~e~e~ ....... /-~.h...JZ.~..~ ...... ~.o.t~.~.~.~..~ .... ~..~: ...................................................... If apphcant is a co~orate, 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 No ............................................... Location of land on which proposed work will be done. Map No.' ...................................//~ Lot No. Street and Number .... ~"y~..~. ...... J~.~"...~--~.-T.- ..... ~...-~ ............ -~- ..... ~.(...~'t....~.z~..,..~.c ......................................... Municipalily State ex~sting use and occupancy o~ premises and in:ended use and occupancy of proposed construction: ::::::::::::::::::::::: ............... - ......................................... 3. Nature of work (check which applicable) New BuJ]d~ng ................ Addmon .................. Alteration Repair ................. Removal .............. Demohtlor ..... ~/.~_ ~_..~ther Work__ .................. ii~'~'~i~ i~'i .......... 4 Estimated Cost ...................................................... Fee .................................................................................... ('.7~.~-~-- (to be pa~d on filing th~s apphcatlon) 5 If dwelling, number of dwelling un,ts ..................... Number of dwelhng 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 Dimensions of ex~stmg structures, if any: Front ....................... Rear ................................ Depth .................... Height ........................ Number of Stones .......................................................................................................... D~mens~ons of same structure w~th alterations or addmons: Front .................................. Rear ...................... Depth ................................ Height ....................... Number of Stones ............................ 8 D~mens~ons of entire new construction' Front .................................. Rear ............................ Depth .................... Height .................. Number of Stories ....................................................................................................... 9 S~ze of lot Front .................................................. Rear ....................................... Depth ............................... 10 Dote of Purchase ................................................... Name of Former Owner ...................................................... 11. Zone or use district in which premises ore s~tuated ............................................................................................... 12 Does proposed constructJon wolate any zoning law, ordinance or regulation: ...................................................... 13 W~II lot be regraded ........................... W~II excess fill be removed from premises: ( ) Yes ( ) No 14 Nome of Owner of premises .............................................. Address ................................ Phone No ...................... Name of Archttect .......................................... Address ................................ Phone No ...................... Nome of Contractor .................................... Address ................................ Phone No ...................... PLOT DIAGRAM Locate clearly and d~st~nctly all buildings, whether ex~stmg or proposed, and red,cate all set-back dimensions fron property lines Gwe street and block number or description according to deed, and show street names and indicat, whether interior or corner lot STATE OF NE~~ '\ .., ~c~ COUNTY OF ~--~' ~"t'/- .... ........................................................................................ being duly sworn, deposes end seys thqt he ~s the ~pplice (Name of ind,v,dual s~g c~tr~c~) above named. ~~, ~ He ,s the .............................................................................................................................................................. (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 this application; Chat all state__ts coneamed ~n eh~s appl,cet~on are tru~ to the best of h~s knowledge and belief; that the woT~ w~ll be performe~ the manner set fo~h ~h~ apphcation ~led ~herew~th. Sworn to be/ore me this / ~ ...................... ........