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Home My WebLink About6171-zBUIL~DING DEFARTMEN~ TOWN CLERK;S oFFICE SOUTHOLD, N~ Y. BUILDING FERMIT (THIS PERMIT MUST BE KEPT ON THE P~.EMIS~S UNTIL EULL COMPLETION OF THE WORK AUTHORIZED) ...... ~....,. ............. .~, ........... -~e.-.., ~¢.?~.-. N°. 6171 Z Dote Permission is hereby granted to: , .&~el~.:~.~r~l~t~~. .................... .....: ............ ........ ~a~-'~ ................................... ;~ ................... ~o ...~¢t..a~...~,~rYm...~e...-:{~..~,~..'a~)':~f*~'~"le~/? at premises Ioc,t,d ot .~0,~..~ ....... ~:~..~e~O~.....~,...,~....,.,.,..,:..,r.,-,.,.? .............. .................................. ......~aeO~..~a~e-.~..~a~ ~,e ~t~ ~,~:, '' ::::' pursuont to opplicotlon d~ted .................... ~.-0~.-"'~ .................. 19..~-, ond oppro~ed bg the Building Inspector. Fee $..1.f.<;~3 .......... FOEM NO. 1 TOWN OF SOUTHOLD'; BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ~' ~- 19.~'~ '~ App o d .............. :.( ......... ........ , 19 ........ Pemit No ......... ~.~ .......... ~ .......... o,c ................ ................................ .............................. (Buildin~ Inspector) APPLICATION FOR BUILDING PERMIT Application No......~..~..?...~ ............... INSTRUCTIONS a. This application must be completely filled in by typewriter or In mk and 'submitted in triplieate to the Building Inspector, wit~t~ 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. P~ot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, andA giving a deta led descript on of layout of property must he drawn on d agram wh ch is part of this application. ¢. The work covered by this application may not be commenced before issuance bf Building Permit. d. Upon approval of th~s application, the Building Inspector will issue a BuJldin~ 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 anv purpose whatever until a Certificate of Occupancy shall have beer~ granted by the Building Inspector. APPLICATION IS H[REBY MADE to the Budding Department for the issuan(:e of a Building Permit pursuant to the Building Zen Ordmanc0 of the Town of Southold, Suffolk County, New York, and other appl[cable'~ Laws, Ordinances or Begulations, for the construction buildings, additions or alterations, or for removal or demoht~on, as hereto described.iThe applicant agrees to comply with all applicable ordinances, building code, housm§ 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. ......................... ...................................................... .i,; ........................................................................ ~'~e' ~; owner of premises ........... ..~.¢:~...~..~...~..~./~....(~...~.,,~...~.., ................................................ : ................ 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.: .~.~.~.....°~..~..~...10. ...... ~...~:~.... Lot No..~.~.~.... Street and Number ............... .~...g.....~ ........~./...~ .................... .,. ............... .~..0..J..c~,M'~.. ........................... ! Municipality 2. State existing use and occupancy of premises and intended use and occi]pancy of proposed construction: a. Existing use and occupancy .................... ~}~...~..~.(..~.~,.~1~...~..,..~...~. .................................................................. b. Intended use and occupancy ..............................~.j~.¢..¢?......C. ............ ........................................................................ 3. Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration ..... Repair ......................... Removal ......................... Demolition ........................ Other Work .....".~..~...f~.....~'....~. ~ I Description 4. Estimated Cost ............................................... 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 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 .................................................................. I ........... 9. Size of lot: Front ........... ~ ...................... Rear ................ ~.b..w ................ Depth ........... ;.~.....o...~. ............... · 10. Date of Purchase ..... t.4..4 ........................ Name of Former Owner ...... 1 1. Zone or use district in which premises are situated ........... l.~.~,~.~.~.;~.~..~.,~.~r.~. .......................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................................ 13. Will lot be regraded ......... .~.....(~.. .............. Will excess fill be removed from premises: [ ] Yes [ ] No 14. Name of Owner of premises ~..~...~ ................................................................. (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 dimensb property lines. Give street and block number or description according to deed, and show street names and indicat er interior or corner lot. STATE OF NEW~YOR~K~ __ ) COUNTY OF .....~....~...~.~.c,~ ....................... ) )ns from wheth- ion; that all the manner ......~...~..~,~.).x..=~.,~..~~' ............................ being duly sworn, deposes and says that he is the applicant a named. (Name of individual si~ing contract) He is the ...................... ~.~ ................................................................................................................................................................. (Contractor, agenh corporate officer, etc.) o{ said owner or owners, and is duly authoriz0d to ~rform or have performed the said work and to make and fil~ this applical statements contained in this application are tru~ to th~ best of his knowlodfl~ and bellof; and that tho work will b~ ~rform~d in sot forth in the application filed th0mwith. ~ ~ ~ {S~a~re of applicant)