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Home My WebLink About9900-Z TOWN OF SOUTHOLD BUILDING TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No. ~ Disapproved a/c ......... .-.-.-~..:: ::. ............ / ~~'-'~' ................... ~ ...~L .......... L~...:....:~. ......... \ ~_ ~ ~ ~ ~ (Building Ins~tor) ~ ~ INSTRU~IONS a. This application must be completely filled in by Inspector, with 3 sets of plans, accurate plot plan b. Plot plan showing location of lot and of buildings on prer areas, and giving a detailed description of layout ofproperty m c. The work covered by this application may not be d. Upon approval of this application, the Building shall be kept on the premises available for ' e. No building shall be occupied or used shall have been granted by the Building Inspector. ~,~ (~,~ 7~ 19 ............ ~ in ink and submitted in triplicate to the [luilding_,_~ to schedule. relationship to adjoining premises or public streets or ~1 be drawn on the diagram which is part of this application. ~-J ~ce: befo~ e issuance of Building Permit. J will issue o Building Permit to the applicant. Such permit~)I ~hout the work. part for any purpose whatever until a Certificate of Occupancy ~21 APPLICATION IS HEREBY MADE to the Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southp{'d, Suffolk County, New York, and other applicable Lows, Ordinances or Regulations, for the construction of buildings, 9/clditions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with oil applicable laws, ordinances, building code, housing code, and regulations, and to l admit authorized inspectors on premises an~'~ buildings for necessary inspections. / (Signature of applicant, or name, if a corporation) / / (Address of applicant) Nome of owner of premis/~ ...... ..~..~..~.~..~/,. ........ ..'~... ...... ....~....~......~... ......... ...~........~....,~..; ............................................................... If applicant is a corpo~z~te, signature of duly authorized officer. Builder's License No ........................ ~ ............. Plumber's License No ................................................. Electrician's License No ...................~ .......... Other Trade's License No ............................................... Location of land on which proposed work will be done. Mop No.: ........................................ Lot No ......................... Street and Number ............ .~..~.~.,0..~..~. .................................................................................................................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisitinguseondoccupancy ........................................... ! ........ ~ff~''~-- ........ ~'~ .......................... b. Intended use and occupancy ~ ~ . 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration .............. Repair .................. Removal .................. Demolitio~ .................... Other Work ................................................... I ~'~ (Description) 4. Estimated Cost ............................................................ Fee ......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, number of cars ............................................................................................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each b'pe of use ........................... 7. Dimepsions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................ Dimensions of same structure with alterations ar additions: Front ....................................Rear ........................... Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ................................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises ore situated ..................................................................................................... 12. Does proposed construction violate any zoning Iow, ordinance or regulation: ........................................................ 13. Will lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises ..... ...~...~........~...: ...... ...~..~.~.. ........ Address ...... ~.~ .............. Phone No~?..~.......~...~..?...~ Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate oil set-back dimensions from property lines. GiYe street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE O~ NEW YORK. I S c COUNTY_OF ....~.f~L..~_ .~..O....~.. ....... f "~ ......... ..~....~,...~.,.. ,/~.,..~...,.....~.:....~.~.~../...~.~. ........................ be ng duly sworn, deposes and says that he is the cpplicar.~ (Name of individual signing contracf) above named. 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 ~ke end file this application; that all statements contained in this application are true to the best of his knowledge and belief; and tk.m the work will be performed in the manner set fo~h in the application filed therewith. Sworn to betore me this ~ 19....~ ........ o, ....... ........ , Nota~ Public,. ................................................... Coun~ .............. ~~...~..:....~.~ ........................... (Signa~re of applicant) ~ ~~ ~A~ c. CO~o~ - NOtAry PU~MC. State of I~ew York