The URL can be used to link to this page

Home My WebLink About16977-z FO~TM NO. fl TO~N 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) ~..~;....~....~...~....%......~ ..-~...?.~..~.~.~ ..................................................... ...~.~~....~.:~........u..~.~.~,~ Building Inspector. Fee $...'~....* ............... Building Inspector Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-180:3 Exaluined......~.~ 1.5, 19~..~. Approved... .o .l.5., Disapproved a/c ..................................... TOW~,! OF SOUYHOt. D Received ........... ,19., . (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ................. , 19... \ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Built~ing 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, aud giving a detailed descript!on 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 Inspecfor will issued a Building Permit to tile 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 ~ Certificate of Occupancy shall have been granted by tile 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 building for necessary inspections. (Signature of applicant, or name, if a corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. APPROVED AS NOTED ' ' ....... If applicant is a corporation, signature of duly authorized officer. ~ 8Ul~ffiG OE~RTMENT AT 18-1ffi2 8 AM ~ 4 PM FOR THE $~NG INSPECTIONS. 2. ~N - ~MING & PLUMBING 3. ~SU~ON 4~ FINAL CONS~UCTION MUST 8E COMPLETE FOR ALL CONSTRUCTION SHA~L THE ~EQUIREMENTS O; STA~ ~NsTR~TiON & ENERGY ~E$, N~ RESPON~IaLE FOR ]. Location of land on which proposed ~ork will be done .................. q~l~ ~B.C~N~7~F~}ON.~8O~ .... Honse Number Street ' ' Hamlet co,u,, o0o .... [{ ......... mo¢ . . . .......... . . d ........... Subdivision '. .................. ~ ................. Filed Map No ............... Lot ............... (Name) ~late exisfing us~ and occupancy of p~ises and intended nse and occupancy of proposed construction: , . ....................................... (Name an~l title of corporate officer) Builder's License No .......................... ' Phunber's License No ......................... Electrician's License No ....................... Other Trade's License No..~..' .~....~... ....... ' ....-* 'r3.,r,,~t~t~f(~'f/_~ot~R'~ll-ff~;k ~hic], apphcable) N~w Buildin .. ..... Addition .......... Alteration ........ ~'?P"" ~., ........... ~moval .............. Demolition .............. Oth~r Work .~.~ ..... 4. Estimated ~s~. '. ~. ~ / ........................... ~.<, (Description) ~ Fee . ~ (to b~ paid on filing this apph~ation) fi. If dwelling, number of dwelling units If garage number of cars ~ ............... Number of dwelling units on each floor ............... 6 If busine'ss, ..................................................... : ....... · ~ommor¢ial or mixed occupancy, specify nature and extent of each typ~ ....... ? ' ' · · ' of use . Dm~nstons of ex~stmg structures, if any: Front Rear .................... tleight 'Numb0r of Stories .......................... Depth,. Dm~ensions ofsam~ stn~cture with alterations or additions: Front ................ ' Depth ' Height ................. Rear ................. 8 ............................................ Number of Stories · Dimensions of entire new construction: Front ..................... IIeigbt ............... Rear ............... Depth .............. Numberer Stories . Sizeoflot: Front ...... i · Rear · 10 DateofPurchase " ............. ' ....' ................. Depth ..................... ' ' ....... ~ .................... Name of Fenner Owner ............................ 11. Zeno or use district in whioh 'premises are situated . 12. · ' ........... . Does proposed construction violate anv zonino luw ~-,' ··' ............................ ....... .... .......................... .. .... · . . · . ... Nam~ of Arddtoct .. . _ · .... Address ...... Nam~ of Contractor }.~.~q~ ~t~a~ .. ~ ~ ¢~... ...... Phone No ................ ..... ~ p~opercy ~oeatea w~th~n~00 feet of a '~ ' ; ..... ~ If es ~ ' u~ua~ we~and? ~Yes ''r',,~ --~.*..t... y ~ Soutbold To~ T~rustees Permit maybe required. ~"' ...} PLOT DIAGKAM Lo¢at~ clearly and distinCtly MI buildings, whether existing 0r proposed, and. indicato all set-back dimonsions from property lines. Giro str~t and blodk number or d~scfiption ae~ording to deed, and show street names and indi~at~ whether interior or ¢orner lot, STATE OF NEW YORK,~ COUN~YOF.. - ' · ........... .' ~ ......... being duly Sworn, deposes and says that he is the applicant v ,~. (Name of mdivid~l-~lg~J n~6ntract~ .... tle is tire (Contractor agent corporate officer ) ............... of said owner or owne~, ~d ia duly authorized to perform or have perfo~ed tho said work and to m~e and file this application; that all statements contained M .this application are true to the best of his knowledge and belief; and that the work will be performed in the manne~ set forth in the application filed therewith. Sworn to before me this .. .