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Home My WebLink About6071-z FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHGLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 6071 Z Permission is hereby granted to: af premises located ot ..................... .~t. ~.~../~..~./. ...... ~O.L~,I.M~.'. ........ ~...~.~,~; .............................. ......... L',...I .......................... ' .............. ;, ................... !"t .................................... pursuant to application dated .................................. 2. Z.../~.?'~'', ~97.~., a~d approved by the Building Inspector. Fee $.l ..................... Application No....~....~.....~.../....' .............. APPLICATION FOR BUILDING PiRMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or Jn ink and ;ubmitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Pict plan showing location of lot and of buildings on premises, relationshi' 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. c, The work covered by this application may not be commenced before issuance ~f Bud ng Perm t d. Upon approval of this application, the Building Inspector will issue a Buildin~j Permit to the applicant. Such permit shah 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 wl~atever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATIQN IS HEREBY MADE ~o the Budding Department for the issu~nc~ of a Building Permit pursuant to the Building Zone Ordinance of the Town otSouthold, Suffo[l~ County, New York, and otlaer applic~J~le IL~ws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described, ~he applicant agrees to comply with all applicable laws. ordinances, building code, housing code, and regulations, and to admit authorized insp'ect~rs on prem sps and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) ..... ~ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, gene~a contractor, electrician, plumber or builder. ...... .............................................................................................................................................................................. Name of owner of premises ~ Oa~O~ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.:,~..~ Street and Number ....Wtl],~.w.,!~.Ol~l,..I,.~, ........................ ,'. M u~j~ty 2. State existing use and occupancy of premises and intended use and ~cc!' ~ancy of Proposed construction: a. Existing use and occupancy ..,],..F.C,l~;J,~]l'..~.~.~fl,~g ................. . ....................................................................... b. Intended use and occupancy ............... ?. ......................................... ~ ....................................................................... 3. Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work ...~.]~.(~.~. .................... (Descripti)n) 4. Estimal~e~l Cost ......~..0..0...,..0.~O. ............................ Fee .....].~..e..O..O. ................................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ...'1 ...........Number of dwelling units on each floor ......................................... If garage, number of cars ............................................................................................................................................ ¢ 6. If business, commercial or mixed occupancy, specify ~ature and extent of each type of use .................................... 7. Dimensions of existing structures, if anv: 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 ......................................................................................... 9. Size of lot: Front~, ....... /...~..~....~...'~.. .............. Rear ........ ~.~[,..~..~. ................... Depth ....... Zi~.'~....~... ........................... Height ............ ~.. .......................... Number of Stories ........../. ........................................................................ 10. Date of Purchase ..................................... Name of Former Owner .......................................................................... 11. Zone or use district in which premises are situated ................................................................................................ 12. Does proposad construction violata any zoning law, ordinance or regulation: .~,.0, ..................................................... 13. Will lot be re~'aded ................................ Will excess fill he removed from premises: [ ] Yas [ ] (Address) (Phone No, Name of Architect .................................................................................................................................................. (Address) (Phone No, Name of Contractor ~ ~.9~ ~.....~, 2~..~[[~..~9~....~,~-~.....: ................. ..... (Address) PHone ~o, PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dime~ ons from property lines. Give street and block number or description according to deed, and show street names and indic~ ~e wheth- er interior or corner lot. I STATE OF NEW YORK, / ~ ~'~ COUNTY OF ...~ ............................... ) ...... ~.~...~.~....~.~ ..................................................... being duly sworn, deposes and says that he is the applicant a )ye named. He is 1.he ..~8~ ........................................................................................................................................................... ................... (Co~zr~ctor, ~ge~ t, corporate o[[~cer, etc.) of said owner or owners, and ~ ~y, ~,qthonzed to ~erform or have performed the said work and to make and file this applic~ statements contained in this application are trpe t~,~' best of his knowledge and belief; and ~hat the work will be performed set forth in the application filed therewith/, ,~ ,:,,,~h ::), j~ tion; that all the manner