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Home My WebLink About6210-z FORH NO. :~ : TOWN OF $OUTHOLD ~; BUILDING ~ DEPAR'r/~EN~ TOWN GEERK'S OFFi(~E SOUTH~LD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~:MISI COMPLETION OF THE WORK AUTHORIZED) N? 6210 Z UNTIL FULL Date Permission is hereby grq~ed to: ,~ ................................. :""ia;:";;': .............. ;~: ...... :c/f'""~'~~'"'~ at premises iocatea ar ...: ......?.,?...~... ...... .:~..~ ......... ~_.~ ...... ~..; ............. ~..A.: ...................... ~ ~ 19~k, and approved by pursuant to application dated .................................................. ~....., ..... .. Building Inspector. Fee $.J.~=..~. ...... Building spector (, TOWN OF SOUTHOLD BUILDING DEPARTMENTi TOWN CLERK'S OFFICE'. SOUTHOLD, N. Y. ........................................ , 19 ........ PemJt No ................ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and ;3 sets of plans, accurate plot plan to scale. Fee according to schedule, t Jbmitted in triplicate to the Building Inspector, witch'' b. Plot plan showing location of lot and of buildings on premises, relationshi to ad oining premises or pubhc streets or areas, a~d~ giving a detaded description of layout of property must be drawn on diagram wh ~h s part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. ..,~' J d. Upon approval of this application, the Building Inspector will issue a Building' Permit to the applicant. Such permit shall be kep~~ 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 be~t~ granted by the Budding Inspector. ~-~'~ APPLICATION IS HEREBY MADE to the Building Department for the issuanc~ of a Building Permit pursuant to the Building Zo~ Ordinance of the Town of Southold, SuffoJl~ County, New York, and other applicable l:.aws, Ordinances or Regulations, for the construetion~f buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable lav~s, ordinances, building code, housing code, and regu lotions, and to admit authorized inspectors on premises and in buildings for necessary inspectior]is. ........ (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is ow~ lessee, ag~nt, architect, engineer, general contractor, electrician, plumber or builder. Name of 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.: ... :. . Lot No .............................................. Street and Number ..~..: .~..~........~..~.......~_'~.ZT~.~....L....~.. ....... .~..,¢...~...,:,...../~...~...)'~..../../.,~?-~..-~'...../~... ........... --~ (,~. , ~,' Municipality 2, State existing use and occupancy of premises and intended use and occqpancy of proposed construction: ..... ' ....... ' .............. b. s .nd ....... ........ Nature of work (check which apphcable): New Budding Addition Alterat o,1.. Repair ......................... Removal ......................... Demolition ........................ Other Work..~...~ (/~... g~.C~. ~..'.r,~ ( Descript on J_ Estimated Cost ~-~2 Fee (to he 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 2 /6 4 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 .......................................... Depth ................................................. Height .................................................... Number of Stories ...................................................................... 10. Date of Purchase ....~...O..~...~..~././...~.?...2r.. Name of Former Owner ...... ..~..~.....~.....~.....~...~..~........~.....~....4.~.., · · 1 1, Zone or use district in which premises are s~tuated ........................ ~,,,,(,~,,,,',~,, ................................... 12, Does proposed construction violate any zoning law, ordinance or regulation: ............. .,J~l,.,~,, ...................... 13. Will lot be regraded ............... ..~.....0.. ............. Will excess fill be removed from premises: [ ] Yes [ ] I~ 14. Name of Owner of premises ...... .~..~. ........... ~.. ........ ..~.-.-..v ............ ~"..-..~'~'" ................................... (Addressy (Phone No. Name of Architect ................... ~r..~ ............................................. i~,~;~'s';i ................................................... (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 dimen property lines. Give street and block number or description according to deed, and show street names and indic er interior or corner lot. (Name of individual si~dng contract] ~0~ G. S~A~Ni~VI'CH ~Contractor, agent, corporate officer, etc. J ;ions from ltewheth- bore named. ]tion; that al of said owner or owne~O~]fi~¢~.~Oa?~t~ri~e~?OYC~form or have performed the said work and to make and file this appli . . .1%.3a-8~ 58 ' nd f :;tatements contained in thi~l~J!~c~@r~11}r~e~l~fhe best of his knowledge a bel e; and that the work will be performed in the manne se~ forth m the apphcat~t~l~i~hQ~ee~, i ~s J ......... .zu ......... ............... ............... , ..................... {/ (Signature oJ appticanu j