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Home My WebLink About6850-z I~O]Y,a~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~REMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6850 Z Date .................... ~3~p~ ......... ~ .............. , 1993... Permission is hereby granted to: E~3k...&.~3.ea~o~...ltanecetr ........................ ............. .~r~.erd; .............................................. to ..e._.z~..g..~...~r~...m~;La.C~..&..c.Qz~ra:L..l'~ce ........................................................................... at premises located at ..,~....~..~..~.$~.{~..~aX'J~oxq..P.J.~ta~'...R~.d...~..~a~':~zaa ................................ ....................................... g~'J.e~a:l;..... ~.~ ~ ............................................................................................ Bqilding Inspector. Fee ............. pu?uant to applicati(? dated .........................Se]}~ ....... '7' ........... , ]9.73.., and~ approved by the MAp oF LAND Exammed Approved FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ""-'~/~ SOUTHOLD, N. Y. Permit No..~.'.!.~.. ,~..~..~ ............. Disapproved o/c ...... ~ ..... ~ ................... '"-'-- APPLICATION FOR BUILDING FERMIT INSTRUCTIONS a. This application must be completely filled in 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. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets o~ areas, and giwng a detailed description of layout ofproperty must be drawn on the d,agrom which is part of this application. c. The work covered by this application may not be commenced before ~ssuance of Building Permit. d. Upon approval of th~s application, the Building Inspector will ~ssue a Budding Permit to the apphcant Such permit shall be kept on the premises available for inspection throughout the work. e. No budding shall be occupied or used in whole or in pa rt for any purpose whatever untd o Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Budding Department for the issuance of a Budding 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 for removal or demolition, as herein described The applicant agrees to comply with all applicable laws, ordinances, budding code, housing code, and regulations, and to/ adm,t authorized inspectors on premises and in buildings for necessary inspections. ~~( ' notur of_apphcant, or name,~ ~.~....if a corporation) (Address of applicant) State whether opphcont is owner, lessee, agent, architect, engineer, general contractor, electnc~an~ plumber or builder. If apphcant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's L;cense No .................................................... Plumber's bcense No ................................................ Electrician's License No ............................................ Other Trade's License No ............................................... 1 Location of land on which proposed work wdl be done, Map No ' ~ Lot No.'.....~.. ............... Street and Number .......... ---.,~./£~ ....... ~...~ ..... ..~.n:~..~,..c....~.. ............... ,(..'~,..~ ......................... Municipality 2 State ex~sting use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisitmg use and occupancy .......................................................................................................................... b. Intended use and occupancy .......... ,,~,,,~,~.!-...~.......~.....~...,.~~ ................................................... 3 Nature of work (check which applicable) New Building ................. Addition ........... -.~Alteration Repair .................. Removal .................. Demolition .................. Other Work ....... ~ ~ J/ (Description) 4. Est,mated Cost ......................... ~.~. ............................. Fee ...... /.. ................................. ~.... .......................... (to be paid on filing this application) 5 If dwelling, number of dwelling units ........................... Number of dwelhng umts on each floor .................. If garage, number of cars ................... : ....... : ................................................................................................ 6 If business, commercial or mixed occupancy, specify nature and extent of each type of use ................ 7. Dimensions of ex~sting structures, if any: Front ............................ Rear ................................ Depth ............... Height ....................... Number of Stories ................................................................................................ D~mensions 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 ....................................................................... 9. S~ze 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 regulation ...................................................... 13. W~II lot be regraded ......................... ,~. Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of prem,ses ..~..;.....~...C~..~~ ........ Address .....~ ........... Phone No ...................... Name of Architect ...................................................... Address ................................ Phone No ...................... Name of Contractor .............. ~::~....z.~ ................... Address ................................ Phone No ...................... PLOT DIAGRAM Locate clearly and distinctly ail buildings, whether existing or proposed, and ~nd~cate all set-back d~mens~ons fron property lines. Give street and block number or description according to deed, and show street names and ind~cat, whether interior or corner lot .......................... ~-~..~-,7/r~..~.. ~~' ................. being duly sworn, deposes and says that he ~s the a2pl~ca (Name ~P mdiwdual signfng contract) above named. He ~s the .................................... ~~.'......~.. ................................................................................. (Contractor, agent, corporate officer, etc.) of so~d owner or owners, and ~s duly authorized to perform or have performed the smd work and to make ~nd f this application; that all statements contained m this application are true to the best of his knowledge and belief, a that the work w~ll be performed ~n the manner set forth m the application filed therewith. Sworn to befor~jne th~s ~. ........................ (day of ..................... ~ 1-~o ~ -, .-, ..... (Signature of apphcant)