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Home My WebLink About22296-ZTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Approved...~.~. .......... 19 ~./~Permit No..~..~..~. ~..~/ Disapproved a/c ..................................... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF HEALTH ......... 3 SETS OF PLANS .......... SURVEY CHECK .................... SEPTIC FORH .............. ~OTIPY | CALL ................... MAIL TO: Date... a. This application must be completely filled in by typewriter or in t~k 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, rel~ionship'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 issued 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 ail applicable laws, ordinances, building code, housing co~, and regulations, and to admit authorized inspectors on premises and in building for necess~pections. ~__,~ (Mailing address of applican~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................... ............. ~::l: of owner o;;remise;. ~.~.~. ~~~ ~~ ~.~ ..... 7~ If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No..~.~..~../..~; ........ Electricians License No../~..~..'~..~. .......... Other Trade's License No ...................... .~O~..~2. ~ .~. ~. ~~ 1. Location of land on which proposed work will be done...~.~ .................... .... ......... ....... ....... House Number County Tax Map~o. 1000 Sectio. ..... ifa ......... Block .... ~ ........ Lot.../.'..Z~ ........ Subdivision .~~.~~ ........ Filed Map No ............... Lot ............... (Name) 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 ..........................................................///~ : .... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration ......... Repair .............. Removal .............. Demolition .............. Other Work ......... , ..... 4. Estimated Cost / . .. ' (Description) · ' - ....................... Fee (to be paid on filing this application) 5. If dwelling, number of dwelling units · · .............. Number of dwellin units on ea If garage, number of cars .... g ch floor ................ 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 ....................... t ............................. Dimensions of same structure with alterations or additions Front Depth ...................... Height ................. Rear ...................... Number of Stories .................. 8. Dimensions of entire new construction: Front ...................... ............... Rear Height ............... Number of Stories ............... Depth ............... 9. Size of lot: Front ........ ii .................. 1~;~ ....................... 10. Date of Purchase ...................... Rear... .................... ' ......... Name of Former Owner ...................... 11. Zone or use district in which premises are situated ..................................................... 12. D°es pr°p°sed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded .............. /2 .... d,. · .4... Will excess fill be removed fro premises: Ye No Name of Owner of p[emi~es .~. '...~... ~.~ ~OAddress ...... .- ........ hone No. 14. ': ................. ,Ad~d, ress fff. t~ one No. · If yes, Southold Town Trustees Permit may be requir~ ..... ~o./.-~ ..... ... 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. FO;:i POURED CONCRETE 2 ~O~JG~., FEAM~f,~G & PLUMBING 4,, Fit, JAL CONSTRUCTION MUST ~E COMPLETE' FOR C.O, ALL CONSTRUCTION SHALL THE REQUIREMEN~ OF TH/ STATE CONSTRU~ON & ENERGY CODES, NOT RESPONSIB~ FOR DESIGN OR CONS~U~ION ERRORS STATEJg'b'~EW YORK, S° / (Name of individual signing contract) ....... being duly sworn, deposes and says that he is the applicant above named. ' (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 are 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 I'his ........ ..... .......... ~-, .--.~ ~./, ~ - gem Qualified in Suffo k County ,~. -----~- (Signature of applicant) m ssion Expires May 22. 1§