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Home My WebLink About6142-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISE~ UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 614~ Z Permission is hereby granted to: ........... ~.~.~.~:..,.'~ ................... ~ ................. to ............. .~,~L. ....... .~.~,.,.~...,! ........... ~;~'L. ................ ot ~rem,~e~'o*oted ot.~.~r-~. ...... /.2...~..~ ........ J.,....T....~..~-~...~.c~ ................ pursuant to opplication d~ted ..... : ......... . ....... ~.........., 19.~...~.~ ~nd opproved by the' Building Inspector. Examined ................. , Approved [\ ~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 19 ........ 19 ........ Pemit No..'~..../..~..]..~',~..~'. ........ Application mo ................................. Disapproved a/c .......... APPLICATION FOR BUILDING PJERMIT ¢5 ° Date ............................... INSTRUCTIONS a. This applicetion must be completely filled in by typewriter or in ink ~nd ~ubmitted in triplicate to the Building Inspector, wit~ 3 sets o~ plans, ~ccur~te plot plan to scale. Fee according to schedule. b. Plot plan showing Ioc~tJon of lot ~nd of buildings on premises, rel~tionshi~ to adjoining premises or public streets or ~re~s, ~n~ gNing a detailed description of layout of property must be dra~ on diagram ~hi~h is p~t of th~s ~pp~ic~tion. c. The work oovered bv this ~pplic~t~on m~v not be commenced before issuance qf Building Permit. d. Upon ~pprowl of this ~pplic~tion, the Building Inspector will issue ~ Buddin~ Permit to the ~pplicant. Such permit sh~ll be kept on~ the premises ~v~ilable for inspection throughout the ~ork. e. No budding shall be occupied or used in whole or in part for ~nV purpose whatever until a Certificate of Occup~ncv sh~ll have beer~ ~ranted DV the Building Inspector. APPLICATION I~ HE~EB~ ~ADE to the Building Dep~rtment for the issu~ne~ of ~ Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk GounW, New York, ~nd other ~pplic~ble ~ws, Ordinances or ~egubtions, for the construction of buildings, ~dditions or ~lterations, or for remowl or demolition, ~s ~erein described. The ~pplic~nt ~grees to complv with ~11 applicable I~ws, ordinances, building code, housing code, ~nd regulations, ~nd to ~dmit ~uthorized inspectgrs on premises and in buildings for necess~w inspections. .... ......... ~ name~ if a cor0orat~on) -- ~'Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...... ............................................................................................ ......................................................................... Name of owner of premises ........ ~.z~..~z.~.~..¢.~.J..lA~.~.D, ....... s;~...~,~.~.~.~)z./~...~.~z.,.M~....<gc, x.~ ............................ 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.../.~.,. ,~../.'~L .......................... Street and Number .....T..~.(.' .~?..~....~..g_~.~.. .......................................... ....................................................................... ,~5 ? 0 Municipality 2. State existing use and occupancy of premises and intended use and occOpancy of proposed construction: a. Existing use and occupancy ..,..~.......~,¢~(~.~.~.~....~ ......................... i ....................................................................... b. Intended use and occupancy .....~.~...,~../~.~.~./7.....:.~..~L.(:....~.....I ....................................................................... 3; Nature of work (check which applicable): New Building ....................... Addition ..................... Alteratior ,~. ........ Repair ......................... Removal ......................... Demolition ........................ Other Wor .. Z . (Descrip >n) 4. Esti mated Cost .....~...~.~...;..O..~). .................. F ee..~.. Z ..~.. :..O ...c-~.. ....................................................................... (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 ......... .~...~z. ............................... 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: ...x~..~. .............................................. 13. Will lot be regraded ..................................... Will excess fill be removed from premises: [ ] Yes [ ] P,o s 2.6. 14. Name of Owner of premises .~....~L4,.e.)~....v..~..w.~.t.l,l..~,.~.?,/-,°~ .~-~,,~ .................................. (Address) (Phone No, Name of Architect .................................................................................................................................................. (Address) (Phone No. Name of Contractor ................................................................................................................................................. (Address) (Phone No. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dime~ ions from property lines. Give street and block number or description according to deed, and show street names and indic~ e wheth- er int~ '~or or corner lot. /?~, ¢/ STATE OF NEW YO [~ '. */.¢(/.* .,~'~ ) SS "~- 1 '~/~ COUNTY OF ......... ~/t~..~. .................... ) ......................... ~...C..~ ................. being duly sworn, deposes and says that he is the applicant ~ bore named. {Name~f individual signing contract) 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 make and file this applit statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed set forth in the application filed therew;th. TERRI LEE ELAK NOTAI~Y PU tate of New York ........................ ~ ......... day of ....... ~ ..................... qual~fi.(~.8~ffe~k County e~ ~ Commission £xplres ~rcl~0, 1~3'~z~ /"~ ,,q /) ota,' ......... ...................... (Signature of applicant) tion; that all n the manner-