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Home My WebLink About6842-z ~0]~ ]~0. 2 TOYtN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.. Y. I~UILDING PERMIT ? (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WQRK AUTHORIZED) /- ' N? 6842 Z Date .................... ,.-~e$)~..-.-{~ .................. ] 9-.~3. Permission is hereby granted to: pursuant to application dated ..,'. .................... '--~r--~l~: ....... ~....'..../...~ 197]..., and approved by the Fee $."J.~'-~-gO ........... Approved ........................................ - {"/~ ~ ] FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIC, E $OUTHOLD, N. Y. Disapproved a/c ..~-.:'~"".--~c"..~- Application N~ ..... !...~. ............ APPLICATION FOR BUILDING PERMIT Date ...~. .~.3'JLO....~.;..~. ......... 19.....~..~ INSTRUCTIONS a Th~s apphcatlon must be completely filled in by typewriter or m Ink and submitted m tnphcate to the Budding Inspector, ~ 3 sets of plans, accurate plot plan to scale. Fee according to schedule b. Plot plan showing location of lot and of buddings on premises, relationship to adjoining premmes or pubhc streets or areas, ~ glwng a detailed description of layout of property must be drawn on d~agram which ~s part of th~s apphcat~on. c. The work covered by this application may not be commenced before issuance of Budding Permit. d. Upon approval of th~s apphcat~on, the Budding Inspector will issue a Budding Permit to the apphcant Such permit.shall be kept the premises avmlable for inspection throughout the work. e. No building shall be occupied or used ~n whole or in part for any purpose whatever unttl a Certificate of Occupancy shall have L granted by the Budding Inspector. APPLICATION IS HEREBY MADE to the Budding Department for the ~ssuance of a Budding Permit pursuant to the Building Z Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances or Regulations, for the constructic buddings, addit~ons or alterations, or for removal or demoht~on, as herren described The apphcant agrees to comply w~th all apphcable I. ordinances, buddtng code, housing code, and regulations, and to admit authorized ~nspectors on premises and m buddings for necessary inspecti, .... ....... (S~gnature of apphcant, or n~ame, ff a corporation) ..... o....C) ......... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bull ...................... ................................................................................................................................................ Name of owner of premises ...... ..-~..~ .~.. ........ ~..: ...... (~../~.~..~...4~...~....'~..~.~..~.. ....................................................... If applicant is a corporate, signature of duly authorized officer. .......................... · ;.....~..,~ ............................................................... IName and title of corporate officer) Budder's License No ......................................................... P~umber's License No ........ ~.-]..~ ...................................... Electrician's License No ........ ~ ...................................... Other Trade's License No. ~ -- ~ / I. Location of land on which proposed work will be done. Map No....,_ ........... ...f2..._7~_;, ........... ; ...... Lot No Street and Number ........... I..~..~...C~.. ....... ~?~..Jm..~.~ ........ ~...~...L..g..(¢~.. ............ ..~.~~ ................... Municipality 2. State existing use and occupancy of premis/e,s~, n~d inter,ted use and occupancy of proposed construction: a. Existing use and occupancy ......................................... .~ ...............// '! ...~-~f.:./ ..................................................... b. Intended use and occupancy ..... :~ ..... '.~...:....~......L!: ..... ! .......... .~...k~ ...................... , .................... 3. Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work ..... .~..~..M..~:..~.. ......... (Description) (to be pa~d on flhng th~s 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 occuoancy, specify nature and extent of each type of use ..................................... 7. Dimensions of existing structures, if any: Front ....... ~... Rear ...... :;-.~....~ .......... Depth ................................... Height .......................... ~.~ .....................Number of Stories ......... :~::. ..................................................... Dimensions of same structure with alterations or additions: Front ....... ~.~ .......... Rear ........ ~[ ......................... Depth .................. ;~.'.~. ............. Height ............. ~ ................. Number of Stories ..:..Z .................................. 8. Dimensions of entire new construction: Front ...... :......~'--~. ........... Rear ............................ Depth ................................ Height ................................................. Number of Stories ..... ~ ............................................................................... 9. Size of lot: Front ............. [.(¢.F.~ ................ Rear ......... [/c.~__,, ........................ Depth ......~..O. .......... .,_, ..................... 10. Date of Purchase ........... .......... Name of Former Owner ........ ~.¢~3..t.!..~ ..... 11. Zone or use district in which premises are situated .................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ....... ~.D. ............................................ 13. Will lot be regraded ............. ~..~.....~ ...... Will excess fill ~e removed from premi, ses: [ ] Yes [~]~No (Address) (Phone No.) Name of Architect .................................................................................................................................................... (Address) (Phone No.) {Address) (Phone No.) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate a(I set-back dimensions fro property lines. Give street and block number or description according to deed, and show street names and indicate whet er interior or corner lot. t BUT-I- EgFIELD. ,. ED 2.0 - ,. POST4- R IL , ALB O DRIVE ~TATE OF NEW YOR,~Z pOUNTY OF~ ~2 ........ ) .................. bem~ dul~ s~orn, deposes and ~a that he ~s the a~phcant above namr Me ls the ..~ .......... ~~ ............................................................................................. [Contractor, agent, corporate officer, etc. J of sa~d owner or owners, and ~s dung authorized to ~rform or ha~e ~erformed the smd ~ork and to make and fde th~s apphcation; that ~tatements contained m th~s a~phcat~on are true to the best of h~s knowledge and behef, and that the work w~ll be ~erformed m tho man set ~orth m the a~p~cat~on fded therewith ............. ...............