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HomeMy WebLinkAbout9690-zTO~VN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHO~.D, N. Y. COMPLETION OF THE WORK AUTHORIZED) 9690 Z pursuant to application dated /~ 'I-~' ~/ 19~!..~.' and approved by the Building Inspectgr. Fee $ ........................ Building Inspector · VAN HOUTEN ASSOCIATES, INC. 420 LEXINGTON AVE. CONSULTING ENGINEERS NEW YORK, NEW YORK 10017 (2121 889-7350 CABLE: VANENGER, N.Y. SHEET NO ...... OF ..... FOB~ NO. 1 TOWN OP SOUTNOLD BUILDING DEPARTMENT TOWN CLERK'S SOUTHOLD, iq. Y. ,e~oproved .................... ~ .... ~ I~.Z...~rmit No. DimpproYed ale ......... f~. ........ [22 ..................................................... ....................................................... ZZ ...... ........... (Building Inspector) Application No..c~..~....~..i?....~.. ................ APPLICATION FOR BUILDING PERMIT · INSTRUCTIONS 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 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 oF areas, and giving a detoiled 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 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. APPLICATtOhl tS 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 alterations, or for removal or demolition, os 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. (Signa?e of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner vf ,-_...i ................ : ................................. ; .................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) · Builder's License No .......................... '-"~C~ .......... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No ......................... Street and Number c~7 Municipali~ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and ~cupancy ............................................... ~ ............................................................................... b. Intended use and occu~ncy . . 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ................ (Descript on) 4. Estimated Cost ................ ~ ......................................... 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 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 ................................ 8. Dimensions of entire new construction: Front .................... · ............... Rear ............................ Depth ........................ Height .................... Number of Stories ............................................... ~..~) ............................................................... 10. Date of Purchose ................................ /. .............. ,'.......Name of Former Owner ........................................................ 11. Zone or use &strict in which premises are ,'tuated ............................. ...~'.~._,-?~.....d~.~ ............ : .......................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ I3. Will lot be regraded. ........................... Will excess fill be re. moved from premises;, ( ) Yes ( ) No Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... 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 ................................ ' ................................................................................................. being duly sworn, deposes and ~ys that he is the (Name of individual signing contracO above named. He is the .................. ~..~...~...~..~ ............................................................................................................................ (Co~ractor, agent, corporate officer, eta.) 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 that the work will be performed in the manner set fo~h in the application filed therewith. ......... ================================= ..... ............. ........................