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Home My WebLink About9925-z l~O~ NO. ~ TOWN OF SOUTHOLD JBUILDING DEPARTMENT TOWN CL~RK'S OFFICE SOUTHOLD, N,. Y. BUILDING Pt:RMIT (THIS PERMIT MUS-E BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) J N? 9925 Z Permission is hereby granted to: ..... ~, '~ ~unmng m~ectoP , FOKM ~TO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ~--~ / 19 ~°~ Appr"~ved iiiiiiiiiiiiiiiiii.~'iiiiii.? ;9~rmit No ..... ~.~..~...~....: .......................................................................... ................... ................. (Suildin~ Inspector) APPLICATION FOR BUILDING FERMIT Date .................... INSTRUCTIONS Applicotion NO. a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plat 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 or areas, and giving a 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 6r 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 a 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 aitera¢ions, 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 corpora_tion~ ..... .... (Address of applicant) State whether applican~is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........ ........................................................... ........................................................................................ Name of owner of premises ...~..., ............ ~.../...~./. .......................................................................................................... If applicant i~ 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 ............................................... land on which proo~sed work will b~e don~.~Map No.: ........................................ Lot No. 1.7~... .............. Location of Number .../.~.......~z.....~m .~/..~.......-.~.... ~ ........................................................................................... Street and Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: , 1.7.4'..': a. Exisiting use and occupancy .......... O..~.~.~..S......~.~'J~.~.~. ... %~. ..... ~ .. b. Intended use and occupancy ................................................................................................................................ 3. Nature of work (check which apolicable): New Bud ng.. ................. Add~t,on' ' ..................Alteration Repair .................. Removal .................. Demolition .................... Other Work:-' ......... ~.~...~....~.~. .......................... ~ ,~. ~ :~ ~ ~ (,De~rlp~on) 4. Estimated Cost ~. ~. ~. ;~ ...................... Fee .......................................................................................... ' ' " . (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling uni~ on each floor ..... , ...................... If garage, number of cars ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each ~pe of use ............................ 7. Dimensions of existing structure~, if any: Front ............................ Rear ................................Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations o~ additions:, F'r~nt~ ............... ~ .................. Rear ............................ Depth ........................ ' Height .... ~..~,,..,.....~* ....... Num~, ~ Sto~es .............. ~ ............... 8. Dimensions of entire new cdnstruction. Front ......................... ~,. ......... Rear ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................... 9.~ Size of lot:. Front~. ....... ~ .....~ ................................. Rear ~. ........... .............................. Depth ................................ ~ JC ' For er l~,~Date of Purchase ............ .~ ........................................ Name of m~,~Own ........................................................ 1 1. Zone or use district in which premises are situated ............................................ ~......; ........................... ~ ...................... 12. Does proposed construction violate any zoning law, ordinance or regulation:. .................. :.~ .......... ~....~ .................... 13. Will lot be regroded' . ........................... Will excess fill be removed from premises; ( ) Yes ( ) No 14. Name of Owner of premises ............. i .................... ¢ ...................... ........................... Phone No. Name of Architect .............................................................. Address ................................Phone No ....................... Nome of Contractor - ' ' PLOT DIAGRAM ~ ~ ' Locate clearly and distinctly aH buildings, whethe~' existing or proposed, and indicate all set-~ck dimensions from prope~y;lines. Give street and block number~ or descriptiop according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW ~OR(, ~ COUN .................. : ....... 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 make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and thru' the work will be performed in the manner set fo~h in the application filed therewith. Sworn to before me this f' NOTARy PUILIC, StJI~ ~T N*~ ~ Comm~on~ ~ ~pirel Marc~ 30,~~