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Home My WebLink About6097-z l~OK~I NO. ~ TOWN O~ SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~,EMISE~ UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6097 Z Permission is hereby granted to: to ............................................................................................ ;'-':" ....................................................... at premises located at LeT I ~/ ' pursuant to application dated .................................=.. J.., 19 and approved by the Building Inspector. Fee $.~.~.~ ......... Building Inspector ~ 3 7/4/ .< ,,)t FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT, TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ....... ~'~..~..m.. .................. , Approved ........................................ Application No....~:':i:,.(,/.. ............. Disapproved a/c : (Buildin~ Inspector) APPLICATION FOR BUILDING PERMIT Date ' ' 19....'i ....... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and fubmitted in triphcate 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, relationship to adjoining premises or public streets or areas, an giving a detailed description of layout of property must be drawn on diagram whibh is part of this application· c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Buildin? 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 whatever until a Certificate of Occupancy shall have been granted by the 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, Suffotl~ 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 inspectbrs on premises and in buildings for necessary inspections· (Signature of applicant, or name, if a e'~rporation) ( dress of applic ~'~" State whether applicant is owner, lessee, agent, architect, engineer, genSral contractor, electrician, plumber or builder. ......... ...................... i .................................................... ; .......................................................................... '' Name of owner of premises :..¢¢~.. <.,p.~..~f,- :r.. .~. ~.~..~.. .................................................. If applicant is a corporate, signature of duly authorized officer. ..................... ..................... · ~' / "~ Lt 1. Location of land on which proposed work will be done. Map No..../...,..,....¢:~.,., o No ...... ..~..~.. ............................ Street and Number .~.'.~.,~..~.....~.','?',?;.~.>.i'..~..;: ...... : ........................................................................ ....... '~' ............. , Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy......~c' -.z,~ ......,. ..................................... ," ........................................................................ b. Intended use and occupancy ................................................................................................................................. .3. Nt~ture of work (check which applicable): New Building ....................... Addition ..................... Alteration. Repair ......................... Removal ......................... Demolition ........................ Other Work ... .7~.... ( Descript~ ~'r~_ /~z 4. Estimated Cost ....~.D.:,.,~.:~ ................... 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 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 ......................................................................................... 9. Size of lot: Front ...................................... Rear .......................................... Depth ............................................... Height .................................................... Number of Stories ...................................................................................... 10. Date of Purchase ..................................... Name of Former Owner ........................................................................... 1 1. 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 [ ] N, 14. Name of Owner of premises,~.,~.m¢~.~¢~~:¢.~.¢~.~,..~f~¢¢;~/~ ~ (Address) / ~ "(Phone No,) Name of Architect ...................................................................................................................... ~.~..~.~ .............. (Address) Name of Contractor .................................................................................................................... (fi~.~;~ ............... (Address) :e wheth- CO~TY OF .......... ~ ................ ...... ~..~&~,,,~- ...................................................... being duly sworn, deposes and says that he is the applicant a~ eve named. (~ of individual siguing eontract ) ......... .............................................................................................................................................................................. He is (Contractor, agent, corporate officer, etc.) o* ~idow~, o~ o~,o~. ~,Sdb~ ~o~iz,a to p,~*o~m o~ h,~. performed the said work and to make and file this applica ion; that all I . K6 statements contained i~q~va~a~9 am~ue,~o,the best of his knowledge and belief; and that the work wdl be performed the manner ~ommi,sion Expire, Morch 30. Ig~S~ ~ ~ ~ ............................. ~..d,v o, ................................... , ............. (~, .....~... ~/ / ,/ No~,,~ ,~,~..~.:...~~Cou~tv ........................... F"~ ................ :'""~'. ........ , .................................. I ¢Signature oJapptlcant}