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Home My WebLink About6314-z FOEI~ NO. :~ TOWN OF SOUTHOLD BUILDING DEPARTJvtENT TOWN CLERK'S OFFICE SOUTHOLD, H. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6314 Z Permission is hereby granted to: · .~..~.~.~,...v...~.~....~~. ............. ..... ~.~~....~. ............. ...:~-/Z:.....:.~.~.,....:~.~, ,o .............. ~~~.....~.._.~.~...~.~~..~. at premses ocated at ~.'~..x~.~J.'....~.'~...~.'..: ..~....~./.~...~....~. ....................... , ................ ~..~ ~.........~. ~~L ..-......~: ............................ Building Inspector. Fee $ ~.~"' Bui [~ling Inspector ZqZ.¢' l'//'/~ t/o, l£77dZ/Z FORM NO. 1 TOWN OF SOUTHOLD . BUILDING DEPARTMENT: TOWN CLERK'S OFFICE: $OUTHOLD, N. Y. Disapproved a/c .......................................................................................... .. Application No. / '/¢"' · ' (Buildihg Inspectorl APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This 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 whibh is part of this application. c, The work covered by this application may not be commenced before issuance df Building Permit. d. Upon approval of this applk:ation, the Building Inspector will issue a Buildin§ 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, Suffolk County, New York, and other applicableS:Laws, Ordinances or Regulations, for the construction of buildings, additions or aJteratlons, 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. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. GEORGE W'. ~ame of owner of premises ....................................................... ~ .............. [ ........................................ .................................. If applicant is a corporate, signature of duly authorized officer. l Narne and title of corporate officer) Builder's License No .......................................................... Plumber's License No ......................................................... Electrician's License No ..................................................... . . Other Trade's License No ................................................... I. Location of land on which proposed work will be done. Map No ............................................... Lot No. Street and Number .'~.z...l....v.~,,~;,e...,z....o..a..~.~.,~J~,.n...n.~.~.~,.??..s.?....~ ~,,I:.o..~...~.~.,y...~,,v..e.,.~B..e.~..~a.5~. ~.a,'C.~Q~,....N..~.~., Munic{paJity 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 one famzl~., reolaenoe 3. Nature of work (check which applicable): New Building ....................... Addition ..................... Repair ......................... Removal ......................... Demolition ........................ Other Work ....w.9. 4. Estimated Cost ...... ~ .................'...~ ...............Fee ................................................................... Ire be paid on filing this application) 5. If dwelling, number of dwelling units ................. Number of dwelling units on each floor ............ If garage, number of cat's ............................................................................................................... 6. If business, commercial or mixed occuoancv, specify nature and extent of each type of use ........ 6 ' ' 7. Dimensions of existing structures, if any: Front ..... .0. .............. Rear ........~..O ............... Depth ....~ Height . ..20.~. ........................ Number of Stories ...... ~'~e ................................... 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 .....4~....~.e~.ce ............... Number of Stories ........................................................... , 141' 9. Size of lot: Front ....... 1..~.~ ........................ Rear .......................................... Depth ....... ..1.~...0..~.. 10. Date of Purchase .....].2J'..~/..?.l ................ Name of Former Owner ...... ]~,~.~.~.~.~...~.,..~.~.;~.{ 11. Zone or use district in which premises are situated ....... .°.~.e....~m...~..1.~...T..9..s..1..~.e..~...~..1..~...1......./,/./.. 12. Does proposed construction violate any zoning law, ordinance or regulation: ........ .~..0. ............... 13. Will lot be. regraded ....... gQ ....................... Will excess fill be removed from premises: [ ] Yes 14. Name of Owner of premises GEORGE W, SH.I.~ ....................................... (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-E property lines. Give street and block number or description according to deed, and show street name er interior or corner lot. Iteration...~ ........... (Description) )hone No.) Phone ~hone NoJ ,ck dimensions from and indicate wheth- STATE OF NEW YORK, , ,) ) COUNTY OF ...... .......... ................................. du, sworn, deposes and says that he is th~ (IVame of individual signing contract) He is the .......................................................... .O..~t..A/..~ .~:.. .............................................................................................. of said owner or owners, and is duly authorized to perform or have performed the said work and to make and fil applicant above named. this applic~ition; that all statements contained in this application are true to the best of l~I~qgrifl~l~d'~bhd belief; and that the work will be ,erformed iR the manner set forth in the application filed therewith. Not,fy Pubhc. Stme of New Yor~< No 52~0344~63 Suffotk cou,~,~ j / " ......... ............... ~:...C......day of .~~ ........... 19 ./~. "~, ' .... ~ : ................... ....t_ ....................... ................ .................... ~ .... {Signature o/appaca~u j