HomeMy WebLinkAbout9983-z FOP,~ NO. 2
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N, Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON TH.E PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 9983 Z
Permission is hereby granted to:
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at premises located at ..........................
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' '. ~, ' pursuant to application dated ............................... ~.d..~...;..(~Oj.,
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FOBM ~'0. !
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Examined
Disapproved a/c ....................... ..~T.~.....~ ................................................
APPLICATION FOR BUILDING PERMIT
............................. , .....
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 end of buildings on premises, relationship to adjoining premises or public streets o~
areas, and giving a detailed description of layout ofproperty must be drawn 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 c/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 Deportment 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 alterations, or for removal or demolition, as herein described.
The applicant agrees to comply with all applicable laws, ordinances, building code, housing code~r~ regulations, and to
admit authorized inspectors on premises and in buildings for necessary~inspections. / /
/ (Signature of app icant,[,~Or nome~if a corporation)
.... ....
-- (Address of ap~F6ant) -- /
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
if applicant is a corporate, signature of duly authorized officer.
(Nome and title of corporate officer)
Builder's License No ........ C~.Lk.~.~.~. .......................
Plumber's License No .................................................
Electrician's License No .............................................
Other Trade's License No ...............................................
Location of land on which proRosed work will be done. Map No.: ........................................ Lot No .........................
Street and Number .......................................................................... ~).lfi/,'~"~...~t..~ ......
Municipnlity
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Exisiting use and occupancy ......... ..C~..¢,~ ..............................................................................................................
b. Intended use ond occupancy ....... ,....~..~.~f~,.k:':.~.~2/~../.~...~...~.~.?-.~ ..........................................................................
3. Nature of work (check which applicable): New Building,. ................. Addition .................. Alteration .................
Repair .................. Removal .................. Demolition .................... Other Work '.,~P-,~/kK.~¢. ................................
(Description)
4. Estimated Cost ....~,9..g ................................................. Fee .[~. ....................................................................................
(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 c(~rs .............................................................................................................................................
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 ................................
8. Dimensions of entire new construction: Front ................... , ................ Rear ............................ Depth ........................
Height .................... Number of Stories .....................................................................................................................
12, Does proposed construction violate any zoning law, ordinance or regulation: ..-.~ ...........................................
Name of Architect .............................................................. Address ................................ Phone No .......................
Name of Contractor ............................................................ Address ................................ Phone Ne.
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from
property lines. Give street and block number or description according to deed, and show street names and indicate
whether interior or corner lot.
STATE OF NEW YORK,
COUNTY OF f~'~
...~c..:~..~.....j~......~.c~.~J~.c.~ ..................................... being duly sworn, deposes and says that he is the applicam
(Name of individual signing contract)
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 make and file
thatbe alitements contained in this application.are, j,~tru,e. .
rna~'t'hi~s-' the work will per'~,F,rrr,F' to the best of his knowledge and belief; and
d.~the manner set forth in the apphcav,,n filed therewith. /,_~application;
Swor