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Home My WebLink About6070-z FOE~VI NO. ~ TOWN OF SOUTHOLD BUILDING DEPART~AENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT : (THIS PERMIT MUST BE KEPT ON THE PREMISE$~ UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne 6070 Z Date .............. : .......................................... , Permission is hereby granted to: to ............................................. ~ .................................................. ,; .......................................................... et premises located ~t ................................................................... ~ ........................................................ pursuont to applicadon dated ................................................... ~...., Building Inspector. , 1~~ Fee ........................ Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMEN~ ~ TOWN GLERK'S OFFIGE~ $OUTHOLD, N.Y. r~ Examined .................... ' ................... 19.....'~.. Approved ........................................ , 19 ....... : Pemit No ........................... ~ ......... Disapproved a/c ......................................................................................... ;.. (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No ................................. INSTRUCTIONS : a. This apphcation must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, w 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 diagram which is part of this application. ¢. The work covered by this application may nc~t be commenced before issuance (bf Building Permit. d. Upon approval of this application, the Budding Inspector will issue a Buildm§ Permit to the applicant, Such permit shall be kept o the premises available for inspection throughout the work. e, No building shall be occupied or used In whole or in part for any purpose wl~atever until a Certificate of Occupancy shall have been granted by the Budding 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 mspect~rs on premises and in buildings for necessary inspections. (Signa~-O're of apphcant, or name, if a corporation) ' (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..................................................................................... ......... .......................................................................... Name of owner of premises ..... ~..~...~.~... ....... ' ......... .......................................................................... If applicant is a corporate, signature of dGly authorized officer. 1. Location of land on which proposed work will be done. Map No.: ....... ~ ............................................. Lot No ............. Municipality 2. State existing use and occupancy of premises and intended use and occjJpancy of proposed construction: Existing use and occupancy ................................ ~' ............... '~"~ ~-~; ~ Intended use and oceu panty .................................................................................................................................. ~ ~3. 4. 5. 6. 'Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration.;. .......... :. Repair ............. .... Removal ......................Demolition ........................ Other Work ..~..~.~..~¢~-.~...¢~...~. ..... ~/~, I Descriptior Estimated Cost ...~.. ...................... Fee ............................................................................................. (to be paid on filing this application) If dwelling, number of dwelling units .................Number of dwelling units on each floor ...................................... If garage, number of cars...................... .................................................................................... . 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 ............................................................................ Dimensions of same structure with alterations or additions: Front .......................... Rear ........................................ Depth ............................................. Height ......................................... Number of Stories ....................................... 8. Dimensions of entire new construction: Front ......................... Rear ............................ Depth ............................... Height ............. ..~.. ............................... Number of Stories ........................................................................................ Size of lot'- Front.___~....,-__...~---/..7.. ,/~..~.~. ............. Rear ....... ~.~.~.,..J~... ............ Depth .../.Z..~..~....~...~.'. .......... 10. Date of purchase ..'~/1~.../~' '~'t~' .~..'.... Name of Former Owner ...~..ff~.~..~..~. ~-...~..:.....~.~...~..~.f~.., ............... 11. ;Zone or use district in which premises are situated ................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ............................................................ 13. Will lot be regraded ....... ~...~.. .................. Will. excess fill be removed from premises: [ ] Yes [~'1~o Name of Owner of premises ~~,.....~.~..~.....~.~,.~., ............ .~..~..~...'T..~..~. ~...~,... 14. /'J (Address) (Phone No.) Name of Architect .................................................................................................................................................... (Address) (Phone No.) Name of Contractor ................................................................................................................................................... (Address) (Phone No.) PLOT DIAGRAM I:ocate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensi. )ns from property lines. Give street and block number or description according to deed, and show street names and indica , wheth- er interior or corner lot. STATE OF NEW YJ~K/'~,,~, ,~ ,~ ) SS COUNTY OF .~,~H~..~'-...~....: .............. y (Nameofindividualsigningcontract) He is the ............... ..~...~.....J~/...7:C...~..~....."'~.,~.,~,.: ....................................................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorize~,~o..I;~rform or have performed the said work and to make and file this application; that all statements contained tn this apphcat~on ~l~f~1~ep~l~i~the,besL~tNh~s knowledge and behef; and that the work will be performed in the manner set forth in the application filed therewiti~.°, 52-03~3 su[;~;tl, Cour~) ' Cornrnissi,on E~<p~re~ Merch 30, ............ 2,,Q,'. ............... day of..~.~... ,~,,/~_.(~..~...~ ..................... 19 ,~,,...~..... Nota rv pu b~~.~'.~'i~. ~~~ n ¥ ~~ .................... .~......;.; , ....... .................. ~ ~, ~/ (Signature o! appttcant)