Loading...
HomeMy WebLinkAbout11223-z FO~ NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N, Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y, 11'971 TEL.: 765-1803 APPLICATION FOR BUILDING PERMIT ApplicationNo. Z/~.Z.~. ..... INSTRUCTIONS a. This application must be completely filled'in by typewriter or in ink and submitted in triplicate to the Buildi Inspector, with 3 sets of plans, accurate p~ot 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 st~e~ or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this apl: cation. c. The work covered by this application may not be commenced befOr~ issuance of Building Permit. d. Upon approvaJ of this appIication, the Building Inspector will issue a Building Permit to the applicant. Such pern shall be kept on the premises available for inspection throughout the work. e. No building shall be occnpied or used in whole or in part for any purpose whatever until a Certificate of Occupan 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 t Building Zone Ordinance of the Town of Southotd, Suffolk County, New York, and,other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for re~noeal or demolition, as herein descriN The applicant agrees to comply with all applicable laws, ordinances, buildia~,codt~, housing code, and regulations, and~ admit authorized inspectors on premises and in buildings for neces~~ '&'~i ;,; ;',~e~ 'd ;'~orporation~ "" ',' .... -....F:~. ~....o-./.~....e¢..o.~..,q..o. ~ ...... .~(Mailin~ address of applicant) ,. ~-/,',c,'7, ,e State whether applicant is ow~(.9._~!Le,~lessee, agent, architect, engineer, general contractor, electrician, plumber ~ Name of owner of premises ./~./~.,/,~*-,4'~. ,~(as .o~ll~o~t~,~t ~'d~ If applicant 'v~rpo,~ion,~ s~ggatura'of duly antborized officer. Builder's License No .......................... /r Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done ................................................ House Num bet Street County Tax Map No. 1000 Section . r. .............. Block ............... Lot ............... Subdivision . .~../.~ A~..~.*4iqame)- Filed Map No Lot ./..2. ........ State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ............................... .................................... b. Intended use and occupancy ..................................... Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... · Other Work Repair .............. Removal .............. Demolition ........................ ~ (Description) (to be paid on filing this application) If dwelling, number of dwelH~ units .. ~ ....... Nmnber of dwelling units 0n each floor ................ If business, commercial or m~ed occupancy, spccty nature and extent of each type of use ...................... Dimensions of existing structures, if any: Front ............... Rear .............. Depth .............. Height ............... Number of Stories ....................................................... D~ensions of same structure with alterations or additions: Front ................. Rear ................. pth ' H 'ght ... Number ofStofies...--?..Depth [~(/~ .... Dimensions o~ entire new construction: Front .... ~' ........ Rear ............. HeiSt .. ~ ~ ....... Number of Stories ... ~ ............. '. ................. Size of lot: Front ...... , ........... ~ear ............... De Date of Purchase ' Na~ne of Fo~er Owner Zone or use district in which premises are situated ' ' Does proposed construction violate any zoning law, ordinance or regulation: ~ ................. .;~..' .......... Will lot bo regraded .. ~ .................... Will excess fill be removed from premises: PLOT DIAGRAM Locate clearly and distinctly all!buildings, whether existing or proposed, and. indicate all set-back dimensions from :operty lines. Give street and block ~tumber or description according to deed, and show street names and indicate whether :terior or corner lot. rATE OF NI W /Ix OUNTY OF.~~..~..~ ...... (~n.t;a.c.tj~t. ..... being duly sworn, deposes and says that he is the applicant bore named. 0 ~1.~4' ~---~ :e is the ...................... ~ ................................................................... ' (Contractor, agent, corporate officer, etc.) f said owner or owners, and is duly authorized to perform or have perfon'ned the sqid work and to make and file this pplication; that all statements contained in this application are true to th~ best of his knowledge and belief; and that the ,ork will be performed in the mannir set forth in the application filed therewith. worn to before me this ' ,' V fi~,[,~_ .~r~u_u?j,I~OTARY PUBLIC, state 0fSta~}'-~NeW YoW,~ // r / k~ature et appucam) ?erm EXpires March 30, 1~ ~ ' , i I U~ B U~',~LAWFUL ~t~I,i~'~I C[RTIFICAT£ (iF OCCUPANCY y4 ' - L APPROVED AS 'HOT.ED NOTIFY BUILDING DEPARTMENT 765-1802 9 AM TO 4 PM FOR THE FOLLOWING iNSPECTIONS: ~, FOUNDATION - TWO REQUIRED ~:OB. gOURED CONCR~E ~. ROUGH - FRAMING & pLUMBING BE COMPLETE FOR C, O. THE REQUIREME~S OF T~ ~ATE CONSTRUCTION ~ CODES. NOT R~PON~I;~ D~SI~N OR CON~RU~IO~ /;4L" "= -'o t .. 4 l© '[ 0 14'-¥' T:-'r-" tt LA , q :.1 C - %: ,',: s_7_.. r~