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Home My WebLink About11728-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 11728 Z Permission is hereby granted tg: ~ .~ at premises located at ............................. ~ ......................................................................... County Tax Map No. 1000 Section ........................ Block ...................... Lot No ......................... pursuant to application dated 19 [~f..~, and approved by the Building Inspector. Fee $ ........................ Building Inspector Rev. 6/30/80 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined ....... ~ .... 19 ... D,sappro eda/cp. ............ (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application NO. // 7 ~ ~ Date ...... ~...~.. f.7..., 19 .~.?. a. This application must be completely f'flled in by typewriter or in ink and submitted ~ 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 or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. 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 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, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections._ ,~.,,,~cr~ ..... 4.. . .......... (Sigdature of hpplicant, or name, if a corporation) .... ........... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..... ~. .............................................................. (as on the tax roll or latest deed) If applicant is a corporation, signa, mre of duly authorized officer. Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of lg,nd on whichvroposed work will be done '~..,2~- ~,~.. ~.~. ~ i i i i i i'.i i i i i i : House Number ~Street Hamlet . 3~/ 3.~-,,~,~ County Tax Map No. 1000 Section .~.~...~. ........... Block .... :~. ' Lot .................. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) ~ 2. State existing use and occupancy of premi~es..and intende~ use and occupancy of proposed construction: a Existing usa and occupancy ............................................ h. Intended use and occupancy ..................... ~.....:: .... ~ ................................... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration~.~.~ .... Repair .............. Removal .............. Demolition .............. Other Work..--)~ ~'/~.. :... ~_~ '/(Description) 4. Estimated Cost ........ ~..z~. ~../...~? .................. Fee ...................................... (to be paid on ~ing this application) $. 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 ........................................................ 9. Size of lot: Front ...................... Rear ...................... Depth ...................... 10. Date of Purchase ............................. Name of Former Owner ............................. 11. Zone ~)r use district in which premises are situated ..................................................... 12. Does proposed construction violate any zordng law, ordinance or regulation: ................................ 13. Will lot be regraded ............................ Will excess fiil be removed from premises: Yes No 14. Name of Owner of premises .................... Address ................... Phone 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 l/nes. Give street and block number or description according to deed, and show street name~ and indicate whether interior or corner lot. STATE OF NE~"'~ORI~_ COU~ .... above named. .... being duly sworn, deposes and says that he is the applicant 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 f'de this application; that all statements contained in this application are t."ue to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this