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Home My WebLink About6275-z 'BUILDING PERMIT (THIS PE~MIT-'MUST BE KE?T O1~ THE PREMISES UNTIL FULL cOMPLETION OF THE ~NoRK ~UTHORIZED) ~ ' N? 6275''z · ':~. Pe~n is hereby gronted.{o: ~o "' .~...w~..,.,~., ,~l/.-.....~:x~.4~.<. ............ ~....: ./..~...~.....~,, ~ ~ ...... ~.~....~...~..~ ........... (~,,,2~ ...... ~'~"'""?'~"~'~°'~"'~'~'"¢~x~'~ ................................................--: ....... :..'.~...~;~4....:.-.....~.'-- - "' ~ ......... ~, ..................................... ,r pursuant to appli¢otioh dated ...~. ................................... , approved by the Building Inspe~;tor.,. FOBM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE i .~ SOUTHOLD, N. Y. Examined ............. /. .......................... 19........7/ Approved .............. ?...~./~.~. ........ , 19~.....~. Pemit No...~...~.:~....~....-~...~ ..... Disapproved a/c ......................................................................................... ;.. (Building Inspector) APPLICATION FO~ PERMIT Date ...... ./.. ........... ..O.. ....................... 19 ...... INSTRUCTIONS a. This application must be completely filled in bv tvpewriter or ~n ink and submitted in triphcate to the Building Inspector, with 3 sets of plans, accurate plot plen to sca~e. Fee according to schedule. b. Pict plan showing location of lot and of buildings on premises, relationship to adjoimng premises or pubhc 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 apphcetion may not be commenced before issuance ~f Building Permit, d. Upon approval of this application, the Budding Inspector will ~ssue a Building Permit to the applicant. Such permit shell be kept on the premises available for mspeeuon 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 been granted by the Building Inspector. APPLICATION tS HEREBY MADE to the Building Department for the ~ssuanc~ 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, additions or alterations, or for removal or demolition, as herein described. ~l'he applicant 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~nature 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. Name of owner of premises ......... ~..~K./...~...~.~....,~,~.~.~.~4~.,-~-v,¢~,,~.~.~....~..~,~ ' t ~ · ~' ~ ............................................................... , If applicant is a corporate, signature of duly authorized officer· ...... . ............ - ............. · (Name and title of corporate officer) 1. Location of land on which proposed work wdl b,e done. Map No.: .... ~ ,~,-.,~...,~.,,5;~ .............. Lot No ............. Street and Number ..... ./.~.~,-~'7....~.~Z~,~ .,~...~.~,~¢,, ............... .................................. ~.,¢¥'l~un~l.Cl~l.~,~.~/. 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ........ ~.,¢~.-~..~..~2.,~....,,~)~'.~,,,f-~.! ........................................................................ b. Intended use and occupancy ..., .,~..x...~.~,~..~.z.~m~f_,.,~,..~ ........................................................................ Nature of work (check which applicable): New Building ....................... Addition ..................... A Repair ............. . ............ Re~!~e~va.I ......................... De_n~olition ........................ Other Work ..~. 4. E:stimated 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 natu~ and extent of each type of u~ ........ 7. D,mens,ons of ex,st,rig structures. ,, 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 ...: Heigh~.~.~..:~.~'.~....~:..." ~ ~ -- ~'-" Number of Stories ...................................................... ,~ .... 9. graze of lot: Front ........ .~"..~ ........... ...... Rear Depth .................... 10. Date of Purchase ..................................... Name of Formatter-. .............................................. ~ , 11. Zone or use district in which premises are situated ....................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ~ ~ ~3.wi, ~ot ~ re~d ................ ~z~.~i, ~25D~x~Z~ ~o~ ~,~: [ ] Y~ 14.Name of Owner of premise~ .............................. ~. ................ (Address) (P Name of Architect .................. -;~=~ .......................................... i~ ................................... ~ ~'~'~:~ .... Name of Contractor ...................................................................................................................................... (Address) hone No.) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-b property lines. Give street and block number or description according to deed, and show street names er interior or corner lot. -. .... t , STATE OF NEW YORK. ) ~ COUNTY ~ " OF ....~,~..~.~.~%. ....................... ~ ........... ~.~.~...~......~:~.~.f:.::;L.~.~...~.~ .................................... being duly s~rn. de~ses and says that he is the applicant ab e named. He is the ....... ~..:.;~ s%~.:~': ............................................................................................................................................................................. ( Co~tr~ctor. a~e~t, corporate officer, etc.) of said owner or owners, and is duly authorized to ~rform or have performed the said work and to make and file statements contained in this application are true to the best of his knowledge and belief; and that the work will be set forlh in the application filed therewith. ............ ~ ................. d,~ o~ ...~~,.~.~.~, ~.. ............................. ~,~,~,,.~,~,~.~,,,,.~,. m~,~ ............................ i'"'i~;i;i; ';~ ;~ii;;;, teration .............. I De~riptior []No lone No.) :k dimensii ~ns from md indicat ~ wheth- this applicat on; that all erformed in the manner