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Home My WebLink About6303-z FOI~H NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~.EMISE~ UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°. 6303 Z Do,e ......... ~C~.. 197~' Permission is hereby granted to: i"-- ~ /~ ' , .. 47':' :- /. ...=.-: ~..>~..~....:.......~~/.~..' .......... -~>,.~:..x:~...: ........ ,o ...... .................... :...... ................................................ at ......................................... premises located at ...~.....~..~.~.~/i~-~.~.~-.~....~~~' ....... :"'~: .................. · ......................... ' .................................... ................... ............... ,..s.o., to app,,eo,,o, do,ed .... .~,,.~...z:: ................. ,...., i,,7:..nd .,pro.ed by the Building Inspector. TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. Disapproved a/c ............................................. : .............................................. Application No, ':;.......T~....~::. .............. APPLICATION FOR BUILDING PERMIT Dote ....... INSTRUCTIONS a, This application must be completely filled in by typewriter or in tnk 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, reJationsh~ip to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on diagram wh~ich is part of this application. c, The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Buildigg 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 issuance 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. 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. (Signature of a'pplicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, ge..neral contractor, electrician, plumber or builder. Name of owner of premises ....,,~.~,.;..~.k~.~,,.i,7./.z.~J.~.~. ......... &.x..f.'.Z.~.~..-. .......................................................................... if applicant is a corporate, signature of duly authorized officer. [Name and title of corporate officer) Builder's License No .......................................................... Plumber's License No ......................................................... Electrician's License No ..................................................... Other Trade's License No ................................................... 1. Location of land on which proposed work will be done. Map No.....~ ......................................... Lot No ......................... Street and Number ....... ~.~,.~ ...... t,~ ......... ~""-~;'("&'"~' ....... ~.--.eg~;,.~.~ ............ ~.~ ~ "~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a, Existing use and occupancy ................ ,~'~-.?¢.~.~;.,~.,'.,.~.:.~:..~. ........ '. ............................................................................. b, Intended use and occupancy .................................................... ,. ............................................................................. = Nature of work (check which applicable): New Building ....................... Addition ....~........~:;./~ Repair ......................... Removal ,. ........................ Demolition ........................ Other Work~ Estimated Cost .........~'.,.~. ~=.~ ...... ~ ................... Fee .................................................................... (to be 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 ... Height ................................................. Number of Stories Size of lot: Front ...................................... Rear .......................................... Depth .................... 10. [;)ate of Purchase ..................................... Name of Former Owner ............................................................... 11. Zone or use district in which premises are situated ........................................................................................ 12. Does proposed construction violate any zoning {aw, ordinance or regulation: ............................................. 13. Will lot be regraded .................................... Will excess fill be removed from premises: [ ] Yes [ ] N(~ 14. NameofOwnerofpremises ~<~.~.~..~.~.~./~.~.~...~x.~'.~'../~./.`''q~.~.~...~``'~..~`/.~'/''`/.".;~A~`..7~TM............................ hone No.) .~.~..rati°n"t ............ (Description) (Address) Name of Architect ...................................................................................................................... (Address) Name of Contractor (Address) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-I; property lines. Give street and block number or descriptio,,n:according ~o deed, and show street names er interior or corner lot. STATE OF NEW YORK. ) ,~.( ~ ~. ..~ .................... ) COUNTY OF ~' ~ ~ '/ ~: ............................... ~ ...................................~. .................................... being duly sworn, deposes and says that he is the. (Name of individual signing contract) He isthe ,""~? ~C~' / /~" ,. ~ r (Contractor, agent, 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 th statements contained in this application are true to the best of his knowledge and belief; and that the work will be per set forth m the application filed therewith. ........... /.:;~ .........~..,...day of~Z .. X]z '~(')/ld* &~ Term Explre~ ~or,h 30, i~ /Si~naZure o~ applicant) hone No.) ,..~.~.~.::..; r)~ hone No.) k dimensi )ns from nd indical a wheth- )lica~t abo~ '. named. s application; that all ormed in the manner