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Home My WebLink About6051-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: ..L.~,.~?~.~.~..~......?'.6,'..~..~..~...~Z ........ i. ...... ../.~..~ ...... ./...~.:~.~.....~..v...~....,. ....... .~ ...... ¢ ......... c,..t,?,~.s.u., .............. ~...g ............. ..... : ...... ~....~..¢~,?~...~,~_~_ ,~"~¥~ ................... i ............. i .................. ~ ....................................... at premises located at ..... : pursuant to opphcat~on dated .................... ;~:C.;, 19.~.~/. ........ , ond opproved by the Building Inspector. Fee FOI~M NO. 1 TOWN OF SOUTHOLD ~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ............... ~).....[ ................ , .7!:. Approved ........................................ , 19. . Pemit No ............................. App.cotion ............... Disapproved a/c ..~ ................ iZ_..~i ....... ~ (Building Ins ctor) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This apphcation must be completely filled ~n by typewriter or m ink and submitted m 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 tot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detaded description of layout of propertV must be drawn on diagram whibh is part of this application. c. The work covered by th~s 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 on the premises avadabie 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 Budding Inspector. APPLICATION IS HEREBY MADE to the Braiding Department for the ~ssuanqe of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other appbcable Laws, Ordinances or Regulations, for the construction of buildings, 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 ....... ./.-.m.~...~/..~...~..)..?:: ......... ...~..~..~ ./...~.~..!.~.. ....... i ......................................................................... 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.: ..,.~...?..~...~.Z.:;....../~..~:....~.:.'7...~., ...... Lot No ............. Street and Number ........ ./.~..,..¢. ....... ~./.~.~.~.~..~,~. ........ ~.~...¢,. ................. i ............................ .~...ct,..7..¢,/'Z~. ~' .c.r:...q~ ........ Municipality 2. State existing use and occupancy of premises and inter~ded use and occupancy of proposed construction: a. Existing u se a n d occu pancy ./~..t~..~.~./Z~,..~. ~...i....,,~ ................... . ...................................................................... b. I ntended use and ooou panoy ~ ...~.~',2.~..(: ...... j. ..................... .~..,.....?. ............ ~..., .............................................. 3, Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration..._.~ ....... Repair ............. , ............ Removal ......................... Demolition ........................ Other W o r k~...~.../¢..~....~.....z?...TX~ ¢2..~..~'-~ (Description) 4. Estimated Cost ....~ ................................. Fee ................................................................................................. {to be paid on filing this application) 5. It: dwelling, number of dwelling units ................. Number of dwelling units on each floor ......................................... It: 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 ................................... Neight ........................................................... 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 ......................................................................................... o~ze of lot: Front ...................................... Rear .......................................... Depth 10. [)ate of Purchase ..................................... Name of Former Owner ............................................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Do'es proposed construction violate any zoning law, ordinance or regulation: ....... ~....~ ........................................... 13, Will lot be regraded ........... .? ..................... Will excess fill be removed from premises: [ ] Yes [ ] No Nam. of Ow.er of premises , ............... (Address) (Phone No.) Name of Architect ..................................................................................................................................................... (Address) (Phone No.) Name of Contractor ............................................................................................................................. (Address) (Phone No,) PLOT DIAGRAM Eocate 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 Y~I~K,~Z~.~ ) SS COUNTY OF ._..~.~ ....... ) .......................................................................................................... being duly sworn, deposes and says that he is the applicant above named. (Name of individual si~ing 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 JUDITH T. BOKEN set forth in the application filed therewith, f~¢,~my Public, State of New York ........................... ,.¢~../.....day of ................ ~....-~.,...,.,~.¢~&9~o,d,.:~*, ,:/~.~ ~/ . .... ~otary v u bi i c.~-~r,~..~ J....... :;~z...~.. ~~o u n t y ............................................................. : ............................................ ~,/ ' (Signature of appflcant)