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Home My WebLink About6089-z FOI~M NO, 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N:. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISE CQMPLETION OF THE WORK AUTHORIZED) UNTIL FULL No. 6089 Z Permission is hereby granted to: l~rank & Mar~.e to ..*.~*.~...~..'~m.~.n..~*...~.~*~..~r~...~.:~.~.~..~.*~.~.~..3.~.~.:~~ ..... at premises located at ........jj,&y..~sl'~.,~lJj~l~q~--.~/1j- .......... ' .......................... ............................... ................................... l~raek , pursuant, to application dated .......... , .......... ,t~.~ .......... 3*J ............... , 19...~j, end op~r:oved by the Building Inspector. · Building Inspector / , (,r FORM NO. 1 TO~N OF SOUTHOLD BUILDING DEPARTMEN~ TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ................ ~.....~..( .............. , Application No ...... ~.c..!.~.~. .............. Disapproved a/c ....... _ (Building Insp/ctor) APPLICATION FOR BUILDING PERMIT Date INSTRUCTIONS %k~ _r~ ~ a, Th~s apphcauon must be completely filled in by typewriter or in ink and ~ubmitted in triplicate to the Building Inspec~r,~ 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, relationshilb to adjoining premises or public streets or a~a,as, and~' giwng a detailed description of layout of property must be drawn on diagram which is part of this application. ~ c. The work covered by tMs application may not be commenced before issuance 6f Building Permit. ~ d. Upon approval of this application, the Building Inspector will issue a Buildin~ Permit to the applicant. Such permit shall beck, pt onl the premises available for inspection throughout the work. ~,,"/Ix /" e. No building shall be occupied or used in whole or in part for any purpose w~atever until a Certificate of Occupancy shall ~9e~beer~ granted by the Building Inspector. ~ ~ / APPLICATION IS HEREBY MADE to the Building Department for the issuanc~ of a Building Permit pursuant to the Buildi-~g Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable iLaws, 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 buildings for necessary inspections. , (Signature of applicant, 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 . .~-~,g:.J~'..~,...../~./.~.z......../~...,/.f.~J.C....~..f..E~..~ 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.: ....... ~ ............................................. Lot No ............. Street and Number ............ ~.'~ ............................................................................. L-//~ ~ : Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... .~....~.'~.~...~.;..~ ............... ~ .............. i ........................................................................ b. Intended use and occupancy ......... .~-~.~.~..~'..% ....... .O.¥.~.~..'.~_~.. ~ ............ ~ ........................... ~ ......................... 11. 12. 14. Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration ............... Repair ............. . ............ Removal ......................... Demolition ........................ Other Work ...z~..~..~...~..~. .............. ( Descriptior F-stimated 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 ..................................... 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 ...................................... Dimensions of entire new construction: Front ......................... Rear ............................ Depth ............................. Height ................................................. Number of Stories ...................................................................................... Size of lot: Front ...................................... Rear .......................................... Depth ................................................ Date of Purchase ..................................... Name of Former Owner ......................................................................... Zone or use district in which premises are situated ................................................................................................... Does proposed construction violate any zoning law, ordinance or regulation: ........................................................... Will lot be regraded ................................. Will excess fill be removed from premises: [ ] Yes [ ] N( Name of Owner of premises .../.~)./~.~ .~..z..~'..../~.~...7....,~....f?.~/...~. ......... ~/.~..~..~. ...... .~.¢.~...~.~./....~.~..~......../~...~.~ (Address) f (Phone No.) Name of Architect ...................................................................... i~J;~'s';i ................................... i~'~"~'~'.i .............. Name of Contractor ................................................................................................................................................... (Address) (Phone No.) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimens )ns from er interior or corner lot. COUNTY OF ................ .~.:...~r...) .................. ~ ......................... being duly sworn, deposes and says that he is the applicant ab ~.(Name of individual si~ing contract) ~He is the ............ ~~ ...................................................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to ~rform or have performed the said work and to make and file this applica~ statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in set forth in the application filed therewith, ~ [ ~- J. DWIGH~EVE ~ ~ ~ ............ ........ ......... .L ........ . No. 5 6 ~ .ot.r....,,. ....... ............. ......... .................................... ~mm~s~ r~r. ~ ~,~ ,ch 30, tg~ (Si~amre of applicant) . wheth- named. ion; that all the manner property lines. Give street and block number or description according to deed, and show street names and indica