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Home My WebLink About5866-zFO~M NO. ~ ~TOWN OF S~UTHOLD BUILDING DEPARTME~IT TOWN GLERK'$ oFFIGE ~ SOUTHOLD, N. Y. (THIS PERMIT MUST BE KEPT ON THE PREMISE',; UNTIL FOLL COMPLETION OF THE WORK AUTHORIZED) 5866 Z Dote ............. 4...~..!.~....! .i... l:~ ............. , ¥c~..., Permission is hereby granted to: at premises located at ,...~. ~t..~.~.~.;., :~{~.~;.~..; .............. !;.~. ............ ;;..,~.;.,;,;,;....:.,.....,...,;..:: .... ............................................. ~.~1~'.,t,,~ ...... ~.,X, ............ ........ ,~....~ .................................................. ~pursuant to apphcahon dated .................. ...:.~ ........ ~...~ ¢,..,f1 ~ :an~. approved, By ~he TOWN Or Sou'rHO DI BUILDING~ DEFART~,EN~ TOWN CLERK'S OF'FiCEi SOUTHOLD, N. Y. Examined ......... ~' // ....~,~....~..,.. ......... , Approved ........................................, 19 ........ Pemit No ........................ T? ......... Disapproved a/c ......................................................................................... (Building ~nspector) ~Dat INSTRUCTIONS Application No ................................ a. This apphcation must be completely filled in by typewriter or in ink and ,~ub, litted in triplicate to the Building Inspector, with~ 3 sets of plans, accurate plot plan to scale. Fee according to schedule, f b. Plot plan showing location of lot and of buildings on premises, relationshi~ to' ad oinin~ premises or public streets or areas, and giving a detaded description of layout of property must be drawn on diagram which i§ part of this application. c. The work covered by this application may not be commenced before issuance ~f B~ilding P~rmit. d. Upon approval of this application, the Building Inspector will issue a Buddin<~ Permit to t~e applicant. Such permit shall be kept on the premises ~vailable for inspection throughout the work. e, No building shall be occupied or used in whole or in part for any purpose w~ate~er until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance ofI a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffoll~ County, New York, and other applicable iLaw~j, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. ~he iapplicant agrees to comply with all applicable laws, ordinances building code housing code and regulations and to admit authorized inspectors o~ prem ses and in bud ngs for necessary inspections. (Signature Of applic"~ht, or name, If a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, gene~a~ :ontractor, e[ectric~n, p~umber or builder.,~ Name of owner of premises "~J~'""~ ' If applicant is a corporate, signature of duly authorized officer. /J'° 7- '~o ~, /~:~ o, ~ 7"x] ~ z70/~_...~ (Name and title of corporate officer) I. Location of land on which proposed work will be done. Map No.: ........ i...-.? ..... Lot No .............................................. Street and Number .. .2~ ............................................................... ~---~tl. ~ t ~ o o ~, i Municipality 2. State existing use and occupancy of premises and intended use and occt~par~cy of proposed construction: a. Existing use and occupancy , ~~-~~ . : , b. Intended use and occu~ancg ............. ~ ~'~ Nature of work (check which applicable): New Building ....................... Additic~ ....... ~ ............. Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... (Description) 4. Estimated 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 nature and extent of 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 ...................................... Rear .......................................... Depth .................................................. Height .................................................... Number of Stories ...................................................................................... 10. Date of Purchase ..................................... Name of Former Owner ............................................................................ 1 1. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ............................................................ 13. Will lot be regraded .................................... Will excess fill be removed from premises: [ ] Yes [ ] No 14. Name of Owner of premises ....................................................................................................................................... (Address) (Phone No.) Name of Architect ..................................................................................................................................................... (Address) (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 dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate wheth- er interior or corner lot. STATE OF NEW YORK, ) SS COUNTY OF ....................... ............................... ) .......................................................................................................... being duly sworn, deposes and says that he is the applicant above named. (Name of individual signing contract) He is the ................................................................................................................................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. ...................................... day of ...................... , ........................... 19 ............. Notary PubEc ........................................... : .......................... County ........................................................................................................... (Signature of applicant)