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Home My WebLink About5978-z FORM NO. '~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT ('rills PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5978 Z Permission is hereby granted to: .......... .~ ...... ~.~.:./. ................................... ...~.......~e...,.~...~.~:.~ ......... ~./.....z..z....~ ~t premise~ Iocc~ted ot ........................................................................................................................... ............................................................. ~...~.~:.g...~....~Z.,~ ............................................ pursuant to application dated ........................... ...~._~......, 1~..~ and approved by the Building Inspector. Building Inspector FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ..................... .~. ........ , 19 ........ Approved .............................. .~./.~. ,~ '7' ..~"'~ 7~?' ........ 19........~emit No ..................................... '~ ..~~ Disapproved a/c ........ ~ .................................................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Dote ........................... ~/, .................. , 19.~..\- ...... INSTRUCTIONS a This application must be completely filled in by typewriter or ~n ink and submitted in triplicate to the Building Inspector, with~ 3 sets of plans, accurate plot plan to scale. Fee according to schedule, b. Plot 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 Building Permit. d Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept 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 HERESY 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 bditdings, 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 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 ....................................................................................... If applicant is a corporate, signature of duly authorized officer. 7-//- (Name and title of corporate officer) f 1. Location of land on which proposed work will be done. Map No.: ..................................................... Lot No ............. d Number ..J.~.: ...... '.~...,~. ...... L ................. , ........................................................................................................ ~treet an ~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of propo~d construction: a. Existing use and ~ccupancy~)~5.~.~¢~v.~.~.~:.~.~).~.~.EQ~L~Z.t.~]~.~`~.L~L ........... b. Intended u~ and occupancy ..:~t,~4~l.~: ................................................................... t ............................................ .~ 3. Nature of work (check which applicable): New Building ....................... Addition ......~, .......... Alteration ............... Repa r Removal ......................... Demolition ..~ .................. Other Work .................................... ~E, .~ o ,o --- ~) ~ ~ (Description) 4. Estimated Co~ ..~...~.~.~.~ ....................... Fee ........ ~ ..................................................................................... (to be paid on filing this application) 5. If d~lling, number of dwelling units ................. Number of dwelling units on each floor ......................................... If gara~, number of cars ............................................................................................................................................ 6. If busine~, commercial or mixed occupancy, specify nature and extent of each type of u~ ...~:.~.~:.~ ............... 7. Dimensions of existing ~ructures, if any: Front ..... ~.~ ........Rear ~ ~ ~ Depth .~ ............................ Height ~ TM I ......................... ' ~ ~ ~ '" ................................. Number of Stories ..~.[E,~ ............................................................. Dimensions of ~me structure with alterations or additions: Front ........... ~ ............. Rear ...~..~. ....... ~..~ .............. Depth ..... ~.~..t.. ..~.( ............... Height / ~ ~ . Number of Stories ...~.~.~ ............................ 8. Dimensions of entire new construction: Front .~..Z..~ .............. Rear ...... Z..~ ............... Depth .~..~ ....................... Height ...... ~../. ..................................... Number of Stories ..~..~. ................................................................................ / , ~ ' 9. Size of lot: Front ......... ~.~. ....................... Rear ...... L.~ ............................ Depth .................................................. 10. Date of Purchase ..................................... Name of Former Owner ..~.~L~:.~. ......................................................... 11. Zone or u~ district in which premims are situated ..................................................................................................... 12. Does propomd construction violate any zoning law, ordinance or regulation: .~ ........................................................ 13. Will lot b~ re~aded ~__~.~ .......................... Will exce~ fill b* removed from premiss: [ ] Y*s [ ] ~o (Address) Name of Architect ..................................................................................... v"'; ............... ~ ~ ~ (Address) (Phone ~o.I Name of Contractor ~.,~f~[E~.~.~t~.~....~.~5....8~...~.~...~%l~.~t~..~;}[ ...... ~..~.=.~ (Address) (Phone No.) PLOT DIAGRAM Eocate clearly and distinctly all buildings, whether existing or propomd, and indicate all ~t-back dimensions from properW lines. Give ~reet and block number or description according to deed, and show street names and indicate wheth- er interior or corner lot. ~. ~ . e+~' , .~ / ~ STATE OF NEW YORK, ~t , ) COUNTY OF ................. . .~..~...~..~ Q..~....~ ....... ) SS .............C--~ ..~ .~_. ....~...~../'~..l~...~..J.~...~.~[.~......~..~J.~ ............... being duly sworn, deposes and says that he is the ,pplicant above named. (Name of individ~l si~ing con~act) He is the ....~..~.~..~..~.~.~.~..~.~ .............................................................................................................................................................. ( Cont~c tor, a~nC co~rate o f~cer, etc.) of said owner or ownars, and i~ duly au~hodzad ~o ~r~orm or hava ~r~ormed tha said work and to maka and file thi~ appHeation; that all s~atamenta eon~ainad in ~his application ar~ ~ru~.~ ~l~ ~li~f; and that ~h~ work will ~ ~ormad in th~ ~nn~r ~t forth in the application filed therewith. Nota~Public,~ntheSt~eofNewYork ~ A ~ .~ ,~ ~ualifl~ m Su~ ~u~y ............... ~..~.~......day of -~'~'"~'lX"~'":'~m~0.~p~.'30,1~ ~ ~ ~ ~ .......... ....................... ....... ~ [S~mre of appl~c~tJ , E D K O 0 . ~L ~-TCH