The URL can be used to link to this page

Home My WebLink About10019-z I~ORi~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N~. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP. EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 10O19 Z at~''' /-/.~ 7~premises located at /"/.~. ,~,~'~. ~.~ ~ -~....~ ....~~d~¢.~ .. ~ -~ .:~.~; .......... ~;~ .......... :~....~......rr ................... pursuant to application dated ........... :~..Z.~ ................ , 19.Z~ and approved by the TOWN OF SOUTHOLD TOWN CLERK'S OFFICE ~UTHOLD, N. Y. ......... Disapproved ~/~ ............................................................................................ ................ ~8uildin~ Insp*ctor) APPLICATION FOR BUILDING PERMIT Date ..~..~..., .................................... 19..~...?..... 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 o~ areas, and giving a detailed description of layout ofpraperty must be drown 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 o 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, as 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, or name, if a corporation} ......... L.. ~ {Address or applicont) State whether appJicap, t is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................................................................................................................................... Nome of owner of premises ......... ~.~.....~'~ .................................................................................................... If applicant is/~ cc~9orate, signatur/e] of duly ou~rized officer. ...................... (~me and title of cSrporate officer) No .............. ................ Plumber's License No ................................................. Electrician's License No ............................................. Other Trade s License No ............................................ Location of ~ond on wh,ch proposed work will be done. Map Ng.: ~.~.~.~..0.~..~.=.~***-**~ ...... Lot No ....... .~..~. ............ ........ ................... --'"'"'" .................. ........ Street ond Number State existing use ond occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ......~,...~,,,~.~. 3. Nature Of work (check which applicable): New Building.. ................. Addition ..... Alteration ........... ~ .... Repair .................. Removal .................. Demolition .................... Other Work .................................................... (Description) (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, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ............................... ,_1., 8. Dimensions of entire new construction: Front .................................... Rear ...... /...~..:~..0..:: ........ Depth .../...~...[.%.6..."... 9. Size of lot: Front lee r Rear .......... ./.¢..f?.../. ..................... Depth /Y-D ~ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated .................'.~..I..~ .......................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ......... ~...0. ......................................... 13, Will lot be regraded . ........................... Will excess fill be removed from premises: ( ) Yes ( ~/' No 14, Nome of Owner of premises ....................... Address ... Phone No ....................... Name of Architect ........................................................................................... Address Phone No ....................... Name of Contractor .... : ..... ~... Addres ¢.;. ;. ..... Phone No. '7.~...S....'..(..~.2.7...7 PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimer~sions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. S'FATE OF NEWx'Y~RJ~- z~. ~ S S COUNTY OF~ ,~,,,,...~.~ ..?..//~. ...... ....................... .,...~.~,~*,,,.,,~,,.,,.~,~...:.~.~ ......................... being duly sworn, deposes and says that he is the apphcan (Na~of individual signing contrac~ above named. He is the ......................../~--~~..~ ....~~ ........................................................................................... ......... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to m~ke and file this application; that aH 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 fo~h in the application filed therewith. Sworn to before me this ..... NatoW Public, ........................ ~.~,~;/2.z~.... ~oun~ .......... ~ ......................... /..: ........................................................ ~ , m, '~ -- · ~/ (Signature of applicant) NOTARY PUBLIC, State No. 52-8125850, S~ffolk Count Term Expires March 30. 1~