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Home My WebLink About6145-zTOWN OF SOUTHOLD BUILDING DEPARTMENT! TOWN CLERK'S OFFICE ' SOUTHOLD, N.. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISE COMPLETION OF THE WORK AUTHORIZED) S UNTIL FULL N9 61~5 Z Permission is hereby granted to: ~~~...~ ....................... i ................. .......... l..l~'ea~,.,~..~.d~.~.~Ve~3~t~l- ...................................................................................... at premises located at .....,.:...iI//~,,,,~.~0~ ................................................................................ .............................................. ........ P~.-.-I~.¥~. ........................................................................... pursuant to application dated .................. ~1~.~ ........ :.~.2~. ...... i"'"' Building Inspector. 19.~.., and approved by the ...... ( ,; ...; ..................... ui aing Inspect[/r Approved ........................................ , TOWN OF $OUTHOLD , BUILDING DEPARTMEN~ TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No. c/$ Disapproved a/c .~~ ........ , ---- (Building~pector) APPLICATION FOR BUILDING PERMIT 19 ......... :.. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ~nk and submitted in triplicate to the Budding 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, relationsh~p 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 apphcat~on may not be commenced before issuance ~f Building Permit. d. Upon approval of this application, the Building inspector will issue a Buddin~j Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used m whole or in part for any purpose wfiatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Budding Department for the issuanc9 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, addmons or alterations, or for removal or demohtion, as herren described. The apphcant agrees to comply with all apphcable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. 'i ~n:;~ ;:; ~a ppli ~.~a"r~;] if a cot potation ) (Address of applica,~-- State whether applicant is owner., lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............ ................................................................................................................. ....................................... ;/.....: ......... ..... . --: _ Name of owner of premises .... C//~./~Z./..u~.:......~.~..~'.~-./?. .................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) I. Location of land on which prop~o~se~d work will be do e. Map NO: ~"* Lot No Municipality 2. State existing use and occupancy of l~remises and intended use~nd occu; pancy of proposed construction: a. Existing use and occupancy ....~....%~.~..~%~......L fZ_...: ........ : .............. ;:., .................................................... b. Intended use and occupancy ...... ..c%.......~:..:'..~...:..~... .................................... 10. 11. 12. 13. 14. Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration .............. n_t~ ..................... Other Work ...~..~.~ Repair ................. :W"- --Rem°v L ............... Demo o Fstimated Cost ....~..~..(.,2....7.,~...~'.~ ........... 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 ........... /...O..~.~../. .................... Depth .......... ,d~.~.. ................................ Date of Purchase /~/z~;/- ~'~/~?~ Name of Former Owner ....... ..z~-.~-~.~...~...z?.......~.&'..~.Z ............................. Zone or use district in which premises are situated ................................................................................................... Does proposed construction violate any zoning law, ordinance or regulation: ................ ~..C~ .................................. Will lot be regraded ...... ..,~...o. ................... Will excess fill be removed from premises: [ ] Yes [ ] No Name of Owner of premises ..... .) .... ~./..~. .~...~../.~.~ .......... ?. ......... (Address) / ~rnone 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 dimensi property lines. Give street and block number or description according to deed, and show street names and indical er interior or corner lot. ~D STATE OF NEW Y__O, RK~,~ , ) COUNTY OF ...... ..~. '.~.?..~:.~ ......................... ) SS ................. ...L~...[.!:.~...~..~...~..~....t~.....~..~...~:.~..~..;J ..................................... being duly sworn, deposes and says that he is the applicant ab (Name of individual signing contract) He is the ................................................................................................................................................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized tA~l~r~ll~?~have~.~ performed the to file this statements conta ned in this application are tr~e~ th~%b~'t ~nowledge and belief; and that the work will be ~rformed in et f th ~ file ther '~ ~ ~ s or 'n the application ' d e~, BLXG, ~¢~ __.~ ........................ xx-'"'r'--' x' '-~- '~:'~'"~'g~ ................................. ~ X/X// // ~/ ~ ........ : ............. ....... .......................... ~ , ~ (S~applicant) )ns from e wheth- }ye named. on; that all the manner