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Home My WebLink About6007-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES, UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 6007 Z Permission is hereby granted to: Building Inspector. Fee ....................... Building Ihspector FOI~M NO. 1 i TOWN OF SOUTHOLD BUILDING DEPARTMENT~ TOWN CLERK's OFFICEi SOUTHOLD~ N. Y. £×ornined ............... ~/. 1...... Approved .................. 1~......C. Per'nit No ................................... Disapproved a/c Application No ............................. ::... (Building Inspector) i APPLICATION FOR BUILDING P~RMIT pate ,~l;t~?....~.~ ............................. , INSTRUCTIONS a. This application must be completely filled in by ty@ewriter or in ink and ~iubmitted 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 ~n premises, " relatlonshll~ 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 comn~enced before issuance f~:[ Building P~rmit. : d, Upon approval of this application, the Building Inspe,Gtor will issue a Buddin~j'Permit to tl~e applicant. Such permit shall be kept on th~ premises available for j~spection throughout the work ' ' e, No building shall be Occupied or used in whole or in part-for any purpose w~jatevef'until a Certificate of Occupancy shall have been ~ranted bV the E~ui[ding Inspector. :. APPLICATION IS HEREBY MADE to the Building Department for the issuane~ of a Buildi,pg Permit pursuant to the Building Zone (~rdinanoe of the Town of Southold, Suffo[l~ County, New York, and other applicable ~_aws, Ordinances or Regulations, for the construction o~ IDuildings, additions or alterations, or for removal or demolitidn, as herein descr bed The app can~ agrees to comply with all applicable laws, ~rdinances, bui ding code, housing code, and regu at ons, and to admit authorized inspectors on premises and in buildings for necessary inspections (Signature c~f 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 ^D~¢~%,~ ~7~",t~ ' '~ , If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ...., ............... Lol~ No...~D~. ...................................... Street and ..umu~ ....: ............... .~..,~. .................. . ............................................. Municipality 2. State existing use and occupancy of premises and intended use and occ~ ~ancy of proposed construction: a, Existing use and occupancy ...... ,,~8.~:~:~. ........................... ~ ....................................................................... b. Intended use and occupancy ........... ~ ............................................ ; ....................................................................... Nature of work (check which applicable): New Braiding' ' ....................... '~ Addition' ' ..................... Alteration' ............... Repair ............. . ............ Removal ......................... Demolition ........................ Other Work ~e33¢e (Description) 4. Estimated Cost 2,,-3.0e00 Fee ..~.~.~...0.0 .......... (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 tvpe of use ..................................... 7. Dimensions of existing structures, if any: Fiont .....................Rear ........................... Depth ................................... ~ Number of Stories ............................................................................. Height ................................. i' Dimensions of same structure with alterations or additions: Front .......................... Rear ......................................... Depth ............................................. Height i ........................................ Number of Stories ........................................ 8. Dimensions of entire new construction: Front ......................... Rear ............................ Depth ................................. Height ................................................. Nurgber of Stories ......................................................................................... 9. Size of lot: Front ~ ...................................... iRear .......................................... Depth .................................................. Height .................................................... N~mber of Stories ...................................................................................... 10. Date of Purchase ..................................... N~me of Former Owner ............................................................................ 1 1. Zone or use district in which premises are situated ................................................... ; ................................................. I. 12. Does proposed construction violate any zomng law, ordinance or regulation: ...... ~[g ................................................. ;.... ........ ~1 Will excess fill be removed from premises: [ ] Yes [ ] No 13. Will lot be 14. Na me of Owner of pre mises .Aarl~e~..~t~'~t~ta..&..~.,..~ g]~,t3~...~lJ~e~.~...~.~.~..~R'~.~.~.~.~9~ ........................... (Address) (Phone No.) Name of Architect ..................................................................................................................................................... (Address) (Phons No.) Name of Contractor ................................................................................................................................................... (Address) (Phone No.) PLOT DIAGRAM Locate clearlv and distinctly all buildingsi 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 N E~YOl~ i~l~ ~(~ ) SS ~~.~ .. ~.~~..: .................... being duly sworn, deposes and says that he is the applicant above named. /' ~ -~ (~ m ~f in~l si~ng contract1 He'*s 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 fil~ this application; that all statements contained in this application are tru~ to the ~is~ed~Bd belief; and that the work will bo performed in tho manner set forth in the application filed therewith No a y Publla~ ~?l~ or mew ~o~ .................... /-g ............ day of