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Home My WebLink About6278-z FOP, M NO. ~ TOWN OF SouTHOLD BU".D:NG TOWN CLERK'S OFFICE SOUTHOLD, ~ ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISE COMPLETION OF THE WORK AUTHORIZED) N°. 6278 Z Dote ........... Permission is hereby granted to: ;UNTIL FULL at premises located at ..... ~.~,~...~;....j~e,~..]~e~....l~e. S2&ei:..~l~a~i, ....................................... Cuteho~ pursuant to application dated .........................~.I~.~ ........ ~.....; ...... , 19;g2.J, and approved by the Building Inspector. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exomined ........................................ I¥ ........ Application No ................................. Disapproved a/c ............................................................................................ APPLICATION FOR BUILDING PERMIT Date .~...~.(~ ~7 .., INSTRUCTIONS a. Th~s application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building 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, relationship 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 application may not be commenced before issuance of Budding Permit. d. Upon approval of this application, the Building Inspector will issue a Building 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 in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuancb of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffo[l~ 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. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. ............... : .................. 'x .......... 3' ............... (Address of applicant) State whether applicant is , lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................................. .............................. : ...................................................................... ~'~'~:' of owner of premises~.' ..~.~..~.~.~.~.~.~.c~...~..~.~Z~.`~.~..~../.~.....~.:.~ ......... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) '~ ' tl ~.'7 i1~. / 1. Location of land on wh~ich proposed wo,rk will be done. Map IXJ.o.:~.~..../~-.~..C'~0t No...~..~. ................................. Street and Number ..~....0 &~ff4/[:-z~f ~,. ~(~O~/(d~ ~ ,~ //~~ ................................................................................................................ .......... 2. State ex st ng use and occupancy of premises and intended use and occupancy of p?posed construction: ~ ~ a. Existing use and occupancy ,.-r?~.'dW...~.~ ......... ff:-./.,4G.q.,z.~..;.~.......~/..~.f/. .................... -W-~,...u:..x;..-:~ ........... : ................. (( I.( ? I! i t b, Intended use and occupancy ................................................................................ ;.~ ................................ -¢~ ............ 3. Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration ....._,~ Repair .............. ..~ .....Removal ......................... Demoli ....................... Other Work ... (Descript or~i .......... {to be paid on filing this application), ,," .......... "'"':":*'"'._ :'" ............. ......... 6. If business, commercial or mixed occupancy, specify nature and extent o~ each type of use ..................................... 7. 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 ....................................... 8. Dimensions of entire new construction: Front ......................... Rear ............................ Depth ............................... Height ................................................. Number of Stories ...................................................................................... 9. Size of lot: Front ....... F._~.~.....r...I..., ....... Rear ....... /..~,....~./....¢2~...¢'.. .......... Depth ...... ..~..~..~ '...&~/. ..................... Height ........................... '///~/'~ ,/ ...... ,/ .............. Number of Stories .......................... ~ ~"'"'"'"'""/~ ...... ~- /c/dh~, . ~. ~/..~ ........................ 11. Zone or use district in which premises are situated ........... ~./.d.:,~ ...... /E .............. --'"'2' ........................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ...... ~...~..~'/'""~ ....................................... 13. Will lot be regraded .....-/¢¢...~...~.. ................... Will excess fill,be removed from premises:_[ ] Ye,s''[,~1~N'3 14. Name of Owner of premises ...~.,..,....~.(...~Z./.~.~.~, ......... . .~/~......~.,/~.~]Z~.~......~.l...d.c.~c/zx'.., ./.~'~.~z~.. (Address) Phone No.) Name of Arch tect ........................................................................................................ t / ~ / ~ ./ _..AAddress)! ~,./ .~ Phone No,) Named(Contractor ..~./..~..'( ~. ~.~..~......~./~......~...~.Z..~....~..O.......~..f..~...~(. .......... ...~...(...~........~.,,~,.~,..~ /~ ~ ~ (~ddress) ~ Phone No.) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-b mk dimenq~ons from property lines. Give street and block number or description according to deed, and show street name~ and indicate wheth- er interior or corner lot. STATE OF NEW YORK, ) SS COUNTY OF .....; ............................. ~, ................ ) .... ...~...~...] ........................ ?../...dX/. < .................... ~ ..... being duly sworn, deposes and sags that he is th~ applicant at eve named. {Name of individual signing contract} .e ~s the .............. D.~/..r<:/..~_~....: .......................................................................................................................................................... [Contractor, agent, corporate officer, etc. J of said owner or owners, and is dulg authorized to perform or have performed the said work and to make and ,;tatements contained in this application are true to tho best of his knowledge and belief~ and that the work will Be set forth in the application filed therewith. ~ .t~.~ (~ ~ ' ~ -~.)'~~"~¢;.;>'~:¢:.~'""f~'~"~,~¢¢~:.~,%';'r ,'~'~',~o,,(_~,/ ')¢' 2'/ // (Signature o] appttca~ this applica :ion; that all ~erformed the manner