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Home My WebLink About6042-z ~0~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMEN'r TOWN CLERK'S OFFICE SOUTHOLD, N.. Y. BUILDING PERMIT (THIS PERM T MUST BE KEPT ON THE PREMISES COMPLETION OF THE WORK AUTHORIZED) UNTIL FULL 6042 Permission is hereby granted Date ..... pursuant to application Building Inspector. Pee Building Inspector TOWN OF SOUTHOLD t~l~/~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE · ~ ~? SOUTHOLD, H, Y. Disapproved a/c APPLICATION FOR BUILDING PERMIT Date ...... ................ INSTRUCTIONS a. This apphcation must be completely filled m 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 tot and of buddings on premises, rBlationship 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 Budding Inspector will issue'a Building 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 untd 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 Regulat*ons, for the construction of buildings, additions or alterations, or for removal or demohtmn, as herein described, The applicant agrees to comply with alt applicable laws, ordinances, building code, housing code, and regulatioos, and to admit authbrized inspectors on premises and in buildings for necessary inspections. ...... ..~_.,.. .................... . .......... :, ....... :.....~ ........... : .......... (Stgnature of appbcant, ~r~ name, ~f a corporatmn) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......... ~,.:(~,..iq.~JE .............. .?). ...... : ............................ ..;,~.;: ........... : ................ 7'2'"'"'7 ....... 'Z ...................................... Name of owner of premises ...(~,,...~.~.M,,~..'.?,,~ ........ .~..:,./~..~..~J:~'.~ ......... ~,~:?:.L~.,~,ZC;~) ..................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Location of land on which proposed work wdl be done, Map No.: .,../. .......... ,~.......,~,~ ....................... Lot No..;.,.,', ..... Street and Number .,..,.~,,...l~,.~..~,,,w,,.,~!..,.~.,J[:.~,,~, ,,~,.,,,,,L~Y~,,,..~'~ .................. ,~,~.,~..~,.~..,,~,,~.~.~J,-Z~,~ .................. " : ~' Municipality 2. State existing use and occupancy of premises anti'intended use and o~cupancy,_~, zl'°f proposed construction: a. Existing' ' use and occupancy ............. g.~. t,;tfl~,.,j~.4...~'¢ ..............J~.~.-.~..L~,~,~,;:~..C;;~:'~- ' " ........................................... b ntended use and occupancy ........... ~;~O,~...I/m.~,~'.. ................ .~'~-'J'.~..?.~..-~';...~.~, ...................................... ................... Addition ..................... Alteration ............... .... va~ ............... Demolition ........................ Other Work .................................... ~umated Cost .,.,Y,......~,~.,,..°,,.,/,*.,l~.,.,/. ........ Fee ......... ~ .................................................................................... {to be paid on filing this application) 5. If dwelling, number of dwelling units ...~.~l~..~d... Number of dwelling units on each floor ...... .J ................................ 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 ....... /.E ...... '.. Rear ....... L~ .............. :~' Depth ................................... Height .................. ~.J~, .................................. Number of Stories ............ .~..~.~,~,..; ............................................... Dimensions of same structure with alterations or additions: Front .,~.~...,,{~. ........ Rear ..,.~..~ ...... I~ .................... t(~ Depth .,, .~..,~,. ................... Height .......... /,~ ................. Number of Stories ,,..~. .......................... 8. Dimensions of ent re new construct on Front ...../:. ................. Rear ...... rt... ........ Depth . . Height ................... L..,~.,./, ..................... Number of btorles ............................................................. ., De.th ..J ....................... ........... 9. Sizeoflot: Front ............. :.~.,.,..~,,, ............... Rear ........... ~,..~. ................ ~,~':~'J~ ~//' 10. Date of Purchase ....... .'~...:../..~....T.-'?...?-..... Name of Former Owner ............. : .............................................................. 11, Zone or use district in which premises are situated ............... .,~,.,.,:.....:..~....2.'.,~,-/~.,', ....................................................... 12. Does proposed constructi(~r~ violate any zoning law, ordinance or regulation: ............................................................ 13. Will lot be regraded ....... ~..~.......~ ............ Will exgess fill beremo~ed~from p)'emises:[~ [,~,~¢b,~ ~/ ~/~ ] Yes [ ] No . · ~',-F. ~ .~..,:~ ~/~ ...~z.7..-~z ..~r/. 14, Name of Owner of premises .......................... ..~..,~.w,~.~+,..--~..,,..,.,.,,,.~,.~ ................. .............. (Address) (Phone No.) Name of Architect ..................................................................... ::.:.,,..,,..-~.~ ....................... ~ ...... ~':"~"~1'~ ............. ........... ............ ............ PLOT DIAGRAM I'ocate 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 s~reet names and indicate wheth- er interior or corner lot, STATE OF NEW..~..RK~.~.~ ~..~ . ) COUNTY 0 ,F? ~.r..~, .~'..~r:~,,., .............. .......................................................................................................... being duly sworn, deposes and says that he is the applicant above named. (Name o~ indipidual si~ing contract) He is the ................................................................................................................................................................................................................. (Contractor, agent, corporate officer, em) of said owner or owners, and s du y author zed to ~rform or haue performed the said work and to make and file this application; that all statements contained in th~s ap~l abort are tr~,~v~,t~{~,~ ~OW[~9e and ~hef; and that the work will be mrformed in the manner set forth in the app cat~n fi ed therew th N~, b' -t ' .* 903/5v({o}k ......................... ~..~.v o~ .......... L~~:.~ ~ ...... ,]