The URL can be used to link to this page

Home My WebLink About6830-z FOl~l~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTI'IOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTklORIZED) N? 6830 Z Permission is hereby granted to: .............. ~,..~.t.j..¢.~,,~ .................................... at premises located at .... .~.,.~..,.....,....9..~.~..:~:../..q...t.~.o..~.t.}). '.',..o..a..c]....(..Q~'..) ........................................... Green~ort D. ~. pursuant to application dated ALI~~ 29 19.?.~ and approved by the Building Inspector. Fee $.?. ~.:.?g. ........... ! TOWN OF SOUTHOLD '~- "~ ' , '~ - BUILDING DEPARTMENT ~ TOWN CLERK'S OFFIGE sou'mOLD, N. Examined .............................. ~,l ~ ~' ~' ...... ' 19~ / ¢~ ¢. ~ Application No~.¢~ ............... Approved , 19.~.. Permit No. ~.¢..¢...~.'...~ ........... O,sapproved a/c ~....~.~....i~~r,Z...~ ....................... ............................... APPLICATION FOR BUILDING PERMIT ..... ........ a This applicahon must be completely filled in by typewriter or in ~nk and submitted ~n triplicate to the Buildir Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b Plot plan showing Iocahon of lot and of buildings on premises, relahonship to adjoining premises or pubhc streets, areas, and gwing a detmled description of layout ofproper~, must be drawn on the diagram which is part of th~s applicatio, c. The work covered by this apphcahon may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Budding Permit to the applicant Such perm shall be kept on the premises available for mspechon th'oughout the work. e. No budding shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupan, shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the msuance of a Building Permit pursuant to ti Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances, ,Regulations, for the construction of buildings, addihons or alterahons, or for removal or demolition, as herein describe, The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in building.,, for necessary inspections. (S~gnature of applicant, or name, if a corporation) ...... ........ ........ (Address of applicant) State wheiher applicant is owner, lessee, agent, architect, engineer, general contractor, electricmn, plumber or builde ..........................................................................................................................................................._.--_ _,, , .,--, Name of owner of premises ...'~dL.~.l.)'..k~k.....'~., ..... .~.~lk.\i~__~...~L'....~..~,~...~.~.~.~ .................. If apphcant ~s a corporate, s~gnature of duly authonzec officer. (Name and title of corporate officer) Builder's License No .................................................... Plumber's License No ............................................... Electrician's License No ............................................. Other Zrade's License No .............................................. 1 Location of land on wh~h proposed~vorkwlll be done. Map N~o~' _ ....... .~ .......................... Lo_t~No ................ .....~ Street and Number ..~.~t~ ..... l~.~..kl~. ................ ~ ..... ...~.~.,~.~.. ...... ..~.,...~ ....... ~ State existing use and occupancy of premises and intended use a.g_r~d occupancy of proposed construction' a. Exls,ting use and occupancy ....~ .......... .~. ~LI~ ~~. ~ b. Intended use and occupancy ......................................................................... .~ ................................. 3. Nature of work '(check'wh~ch applicable). New Budding .................. Addition ................. Alteration ...... Repair .................. Removal = ................. Demolition ................... Other Work ..... ¥.~....~.~ ....................... ~ Z ~ (D~cription) 4 ~timated Cost ............. ~.~ ..................................... Fee ................................................................................... (to be prod on filing this application) 5. If dwelhng, number of dwelling units ........................... Number of dwelhng umts on each floor ................ If garage, number of ~rs .................................................................................................................................... 6 If bus~ness, commercial or mixed occupancy, specify nature and extent of each type of use ................... 7 Dimensions of existing structures, if any: Front ......................... Rear ................................ Depth .................. Height ........................ Nu~er of Stori~ ....................................................................................................... D~mensions of same structure w~th alterations or addmons Front .................................... Rear ............. Depth ............................... Height ........................... Number of Stones ............................. 8. Dimensions of entire new construction' Front .................................. Rear .......................... D~th ......... Height .................... Number of Stories ................................................................................... ~Size of lot' Front .................................................. Rear .................................... Depth ..................... 10. Date of Purchase ................................................. Name of Former Owner .................................................. 11. Zone or use district in which premises are situated ..................................................................................... 12' Does proposed construction violate any zoning law, ordinance or regulat=on ........ ~..O. ................................... 13 Will lot be regraded ............................ Wdl excess fill be removed from premises' ( ) Yes ( ) No 14 Name of Owner of premises .................................................... Address ................................ Phone No ..................... Name of ArcMtect ..................................................Address ................................ Phone. No ...................... Name of Contractor ................................................. Address ............. .~z ............. Phone No ...................... PLOT DIAG~M / - Locate clearly and distinctly all buddings, whether ex~ting or ~roposed, and indicate all ~et-back dimensions fron property lines. Gwe street and block number or descr pt:on accdrdmg to deed, and show sjreet names and indicate whether in~erior or corner lot /go STATE OF NEV,J,.,YORK- · [ S S COUNTY OF ;...~.' ..~0.[.~......~' ~ ._,,..._ ..~.~...~....¢~L~, ............ ..~.'.., ..... i..L.C~..~...~..~L.~...~.., be,ng duly sworn, deposes and says that he ,s the apphcom ~j~.ame of mdiwdual s~gmng con~) above named. ~s the "-- '~'~'"'"~ -"~/~ ......................................................................................................................................... (Contractor, agent, corporate officer, etc ) He of said owner or owners, and ~s duly authorized to perfcrm or have performed the sa~d work and to make and fd~ this apphcot~on; that all statements contained ~n this apphcohon are true to the best of h~s knowledge and belief, onc tha~ the work will be performed in the manner set forth in the apphcot~on filed therewith Sworn to before~ne this _ -- -- ........... ........ // // ~ ~ JUDIT~ T BO'K~N g ~r~r~,~T appucont/ Notary Pubhc, Sla~e of New Yo~ No 52-03449~:3 Suffolk County /' Commission Expires March 30~ ]~-~L~