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Home My WebLink About6036-z FO~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~EM]$ES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne 6036 Z Permission is hereby granted to: · 6~e~'o~'*'~ ~¢~ ~. '*&: ':¢~ ~'~e .............................. ........ ~.~.~,,;~,S...~,,Y.J,~: ............................................. .......... ~ c~t. ~.~.e.~4~ .................................................. to .~me~,t,.. az¢...~r~;~z:~.~ ~ ~,..a ..s ~t&.t .. -~;a.t.1 .. ~.~e ......... ~ ............................................. ........... at premises 0cated at "'T~ot'"t'~' ...... 'Ba,~et¢"~o~ ........... ~ ................. ', ...................................... .................................. ~.a~s'"~rzv~' .... ~th~d pursuant to application dated ,. ........................ ~t~'g'"'~ ............ i'"*' 19..~7,. · and approved, by the Building Inspector. Fee ~ '~"~,~)0 ............. FORM NO. 1 TOWN OF SOUTHOLD ~ BUILDING DEPARTMENT! TOWN CLERK'S OFFICE SOUTHOLD, N. Y, Approved ~t " 19..~..~.. Pemit No. ~/~ Application No. ~/0-~ ~ . //~) Disapproved a/c ...~ ...... (Building Inspector)/ APPLICATION FOR BUILDING PERMIT '-,4 Date ......................... ( ....... , 19..~',~ .... INSTRUCTIONS . din~ a. This application must be completely filled in by typewriter or in i~k and submitted in duplicate to the Buil Inspector. 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 ofproperty must be drawn On the 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 ~ Building Permit to the applicant. Such permitO,~ shall be kept on the premises available for inspection throughout the progress of 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 ~or removal or demolition, as herein described· The applicant agrees to comply with all applicable laws, ordinances,~ildi~g code, housing code,/a~d regulations. _,7' ........ ,'~'- ' (Ad'dress of applicant) ........... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises If applicant Js a corporate, signor duly authorized officer. (Name and title of corporate officer) ~-~ ,~' 1. Location of land on which proposed work~.)ll be done. /~ap ~o.: ....... ,.~....~,_~..U,...~......~. ...... Lot No ..... ~. .............. Street and Number .... ............. m_z--~.,.....,:....~~= ..................................... ,, Municipality 2, State existing use and occupancy of premises and intended u~nd o~cuponcy of proposed construction: a Exisit n use and occu anc · g P Y ............................................................................................................................. b. Intended use and occupancy 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .................. I~moval ..................Demolition .................. Other Work (Describe) ..~...~ 4. Estimated Cost ........... ''~c~.~...:.....O....0. ......................... 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 .................... '"Z. ..................................................... ~ .................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............. '-Z .............. 7. Dimensions of existing structures, if any: Front ........Z~. ............. Rear ....... ,~.~. ................... Depth ..~...D....~. ....... ' Height ............ Numar of Stories .......................................... :.;ff ........................................... ................ Dimensions o~same structure with alterati~hs or additions: Front ...~..~.~. ............. Rear ...~~ ...... Depth ...~..~Z~-;~'''/' ........Height .....u,~..~....Number//X~ of Stories'' ~x//..~..___________________~.. ........ 8. Dimensions of entire new construction: Front ........... '.'~ ....................... Rear ......... ..~ZT.. ............... Depth ......... .'T. ............ Height .................... Number of Stories ...................................................................................................................... 9. S,ze' of lot: Front .....~..~..~.. ...... ~ ..... Rear ................................... / . .~..~ Depth ......................... /4~'~--~ ' ~ .~.... ~ z~J._~.- .~ , 10. Date of Purchase .... /...~.1....?.._.7. ............ Name of Former Owner 1 1. Zone or use district in which ~emises are situated .................................................... .v ............................................... 12. Doe~ proposed construction violate any zoning/~,, ordinance or regulatior~ ..... ~ ................................................ 13. Name o Ow r o prem,s ...... Address ..................... Phone No. ~.~..~.~..,...~f ne f ' e 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 whether i'nterior or comer lot. STATE OF NEW )/ORI~,./,,/~ t c c COUNTY OF ~~.~'~ ................................................................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing application) abow~ named. 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~ the best of his knowledge and belief; and that ~he work will be performed in the manner set fo~h in the application ~l~¢therewlth. Sworn to he--me this ~ ................... ........... ....... ........... Nota~ Public,~.~.M ~Z~ty / (S~ature~f ~ JUDITH T, BOKEN ~