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Home My WebLink About11809-z (THIS PERMIT MUST BE KEPT ON THE Pi~E/~I! COMPLETION OF THE WORK ~UTH~)P~IZEI~) i ~o.~ ...... ~.~.~.~....~* ........... ~..~: .... Bailding Inspector. ~"-~ i :S UNT L ~:ULL nspectOr ? - :.~ FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL · SOUTHOLD, N.Y. 11971 TEL.: 765-1B02 Approved..d /7.. D~sapproved a/c ......... -,- .................... y./. ...... , ................................ APPLICATION'FOR BUILDING PERMIT Application No..//.(~.d)..~. ........ Date .................. ,19~z. 7. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted.-h,~%'--3.!i._ah- to the Btlilding Inspector, with 3 sets o£ 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 is*ue 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, Or~iinances 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. ... d (Signature of applicant, or name, if a corporation) ............. z'~'~''/ .... L''';~''; .......... (Mailing address of apphcant) 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, signature of duly authorized officer. (Name and title of corporate officer) Builder's License m°' ' i i ~ ~.' .' Plumber's License No. Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. House Number Street Hamlet County Tax Map No. 1000 Section .... /./~ Block ~ Lot Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupan~ of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ... b. Intended use and occupancy, ...,~...o~.~...~; ...... .~{. ~.~.~ .......... ; ............................. 3. Nature o£work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair Removol .............. Demolition .............. Other Work.. f~7.~.q~V.~ ..... . (D ripti ) (to be paid on filing this application) 5. If dwelling, number of dweliing units ............... Number of dwelling units on each floor ................ If garage, number of cars ......................................................................... 6, If business, commercial or mixed 0ccupancy, 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 construbtion: Front ............... Rear ............... Depth ............. Height ............... Number of Stories ...................................................... 9. Size of lot: Front ............ ' .......... Rear ...................... t Depfl~t .... .,, .............. 10. Date of Purchase ............................. Name of Former Owner 1~. '..~?T.~PJ.~;;~..toe.. '. ........ 11. Zone or use district in which premises are situated ................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ...'~. ......................... 13. Will lot be regraded .......... .................. Will excess fill be removed from premises: _Yes No 14. Nme of Owner of premises .................... Address ................... Phone No.~...3.c~.-. Nm-ne of Architect ........................... Address ................... Phone No ................. '\ Nmne of Contractor ......... i ................ 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 Y,~R~(,/ (Name of individual sig0ing contract) 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 file this application; that all statements contained in this application am true 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 thi~ /opm ~'Nota~.y public, S[~ate of New York // Oomrnlsslon t. xp re~ *aa ~ ~ ........ (Signature of applicant)