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Home My WebLink About10792-z FORM NO, ~ TOWN OF SOUTHOLD BUILDItqG DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTI~ORIZED) N? 1079 Z Permission is hereby granted to: pursuant to app[ication dated ..... ~...~.~'. .................................. , 19 ......... and approved by the Building Inspector. FORM NO.?i · · TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 ~ TEL.: 765-180:~ .,'APPLICATION FO~ BUILDING PERMIT INSTRUCTIONS a. Y~his application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspe6t0f, 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 parr of tbJs appli- cation. c; ~l~e work covered by this application may not be commenced before issuance of Buliding Permit. d. Up. on approval of this apphcation, the Building Inspector will issue a Building Permit to the apphcant. Such permit shall b6 k~ept on the premises available for inspection throughout the work. · e. N6 ~uilding shall be occupied or used in whole or in part for any purpose whatever until a Cer~ificate of Occupancy shall have been granted bg the Building Inspector. APPLICATION IS HEREBY MADE to the Building Depamnant for the issuance of a Building Permit pursuant to the B ilding Zone Ordinance of the Town of Southold~ Suffolk County, New York, and other apphcable Laws, Ordinances or Regulati6hs,~for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The ap~iicant agrees to comply with all applicable laws, ordinances, building code, housing goje, and regulations, and to admit ~u{hor/zed inspectors on premises and in buildings for necessary inspections. / /f ~ g ./ . ............ (Signature of applicant, or n~rne, if a corporation) ~- ~ '_ (Mail:rog address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .... ~ .~.~...J~. ..................................................... (as on the tax roi1 or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..... ~ ...... .../... Plumber's License No ........... ~ ....... Electrician's~ License No ........ /...~:/ ~x ........... Other Trade s License No. ~ .~ 3. Nature of work (check whicl~ applicable): New BuL~ling . ..../..... Addition .......... Alterado ..... .... Repair .............. Removal ....... ..... ~2. De~m_~tion .., ............ Other Work.. ~? ...... 4. Est~ated cost ....................... ' ' .............. ~' 'fi' ' '.',-- ' Z7 ....... ~(to~e p~d on fil~g ~his a~ricafion) 5. If dwe~ng, number of dwe~g units ............... Number of dwel~ng units on each floor If garage, number of c~s ....................................................................... 6. If business, commercial or mhed oc~p~cy, specify nature and extent of each type of use 7. D~ensions of exist~g structures, if any: Front ............... Rear .............. Dep~ ............... HeiSt ~. ~0. ~.. Number of Stories . ~ ..................................................... D~ensions of same structure with alterations or additions: Front ................. Rear Depth ...................... HeiSt ...................... Nmber of Stohes ..................... 8. D~ensions of entire new construction: Front ............... Re~ ............... Dep~ Height ............... Number of Sto~es ........ 7. ............................................. 9. She of lot: Front . .~..~ .......... Rear.. 7~O.~e~ ............ Depth &~. ]SP.~ ..... 10. Date of Purchase . . ~~ ................ Name of Foyer Owner 1 !. Zone or use district in which premises are situated.. ~J~ ~.~~ ...................... 12. Does proposed construction violate any zo~ng law, ordinance or regulation: ................................ 13. Will lot be regraded . ~ ......................... W~I excess fiH be removed from premises: Yes ~ No Nme of Owner of premises.. $~. S,. ~:-Address. ~. ~e,. ~. ~ne No. 14. Name of Architect ~ , Address ................... Phone No. Nme of Contrkctor .................... ' ...... Address ........ ........ ~.. Phone No..... : ,..~ .... PLOT DIAGRAM Locate clearly and distinctly all bnildings, ~heIher existing or. proposed, and indicate all set-back,, dLm~n~ons: ';., ~;": ~fr°m-. lines:.Give street and block number or description according to deed, and. show street names and ~ica¢~ whether interior or ff{ IDJ3~ '~bi~ D '~' I I t I I I // STATE OF NEW YORK, ' S S COUNTY OF...~-?q .x~.~..C.~ ./~...." .. ~ ',.,