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Home My WebLink About6200-z ~oa~ NO. ~ TOWN OF SOUTHOLD BUILDING D~PART~,E~N~ TOWN GLERK'S OFFICE SOUTHOLD, N~ Y. ' BUILDING 'FERMIT (THIS PERMIT MUST BE KEPT ON THE PR~MISI~S UNTIL EULL 'COMPLETION OF THE WORK AUTHORIZED) Ng'~i.;.' 6200 Z Oote .. Permission ~J: ~.~ ...................... ..... ¢~:~.....~..~Z-...~..~.~..~...~ ................ ...... (~;~..~.~ .......... ~.....~..~ ........ ~..__..~ ...... ~.._.~ ............. ~ ........................................ ............... - .................. Building Inspector. Fee ....................... ; Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT. TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined L~C//~ '~)' ('~ ~7 1~ Approved ........................................, 19`?2 PemitNo. '~-~r 0 ~ Disapproved a/c ................................................... ~'"i' pp ication No ........... T.....~ ............... ( ulTg Inspector)\ APPLICATION FOR BUILDING PERMIT Date ............ ..~...(.:..~... r..~..~;;. ........... , 19..?._.'.~. ~ INSTRUCTIONS ;. a. This application must be completely filled in by typewriter or in mk and s~bmitted in triplicate to the Bud ng nspeetor, wi~ 3 sets of plans, accurate plot plan to scale. Fee according to schedule. :, · ~. Plot plan showing location of lot and of buildings on premises relationship, to adjoining premises or pub c streets or areas, an-'[I gJvmg a detailed description of layout of property must be drawn on diagram which is part of this application. c. The work covered by this application may not be commenced before issuance o~ Building Permit· d. Upon approval of this application, the Building Inspector will issue a Building' Permit to the applicant. Such permit shall be kept the premises available for inspection throughout the work, e. No building shall be occupied or used in whole or in part for any purpose wh'atever until a Certificate of Occupancy shall have b~ granted by the Building Inspector· APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zo~ Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction ~f 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 inspectdrs on premises and in buildings for necessary inspections. (Signature of applicant,~or~ c~oorporation)i'~ .... ......................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, geneFal contractor, electrician, plumber or builder. .......................................... ......... ,. ................ Name of owner of prem ses ,~..K.~..~ ............................., ........................................................................ If applicant is a corporate, signature of Name and tltl:"~'~'~;~'r'~'~¥t~i~'~'~ii,~' 1. Location of land on which proposed work will be done. Map No.: Lot No. Street and Number ..... ~,V.[~...~...~..~/.~-z.....~..~ ........ .~....~'.~.~ ....................... ; .................... ~...~.~...~..-~/.AK~.....~....~.. .............. i Municipality 2 · State existing use and occupancy of~r. emises~L~_~_~L_~L~a~d intended use and occupancy, of proposed construction: a. Existing use and occupancy ............ ~. ....... ...~...~, .............................. ~ .................................. · ............................ bntended use and occu anc -. p y .............................................. ................ ............... .............................. Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration Repair ......................... Removal ......................... Demolition ........................ Other Work ..................... ( Descript on) Estimated Cost ............................................... Fee ..~. ........................................................................................... Ito De 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 ................................. Hei§ht ................................................. Number of Stories ........................................................................................ Size of lot: Front ...................................... Rear .......................................... Depth ................................................ Height Number of Stories .:;~. .............. 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 [ ] o Name of Owner of premises ..................................................................................................................................... (Address) (Phone No. Name of Architect .................................................................... (Address) (Phone No.) Name of Contractor ......... ..~.'.~.Q.....~...~....~.~.x~....O...~.:~-/-~.~.. .~..~/../~..,.t;.(~ ?.~..~..~.~..41-~ ........ (Phone No.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this applic 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 therewith. .~i~H m,'-,~m, . ............. - N pla ry p1]~,~..:.:." ...........~~'>..,,.~.,............. County ~,,.~-.~ ......... (Signature o£ ~pplic¢,t) tion; that al n the manne ..~ PI~OT DIAGRAM Locate clearly and distinctly all buil~gs, whether existing or proposed, and indicate all set-back dimen ;ions from property Hnes. Give street and block~numb~r~r, descrip, tion according to deed, and show street names and indic ~te wheth- er interior or corner lot. STATE OF NEW YORK, COUNTY OF ....... ~ ¢¢t~'...t~.~. '.~.~..~.~ ~ ................... ) ............................ ~ ......... ~.'.~i~..~{/. ............ being duly sworn, deposes ~,d says that he is the applicant, Dove named. (Name of individual signing contract) He is the ................................ .~.~ o~J.~."~:....~...~... ..................................................................................................................................... (Contractor, agent, corporate officer, etc.)