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Home My WebLink About6875-z FORI~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH~LD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE Pi~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 6875 Z Building Inspector. Fee $l ...................... Building Inspector / , ~*~ ~ TOWN OF SOUTHOLD ~ .o/· : / ! - ~ BUILDING DEPARTMENT"~/~7/ ~ TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ...... ............................ Application No ............................. Approved ........................................ , ........ Permit No .................................... O i ~pproved a/c ................................ APPLICATION FOR BUILDING PERMIt. INSTRU~IONS ~:,a, This application must be completely filled in by typewriter or' in ink and submitted in triplicate to the Buildir Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to s,~,hedule. , b. Plot plan showing location of Iai and of buildings on premises, relotlonsmp to adjoining premises or public streets ~ areas, and giving a detailed description of layout ofproperty must be drawn on the d~agrom which is part of this applicatior c. The work covered by this application may not be commenced bef~¥smoj~,c~,of Building Permit. d. Upon approval of th s appl cot on, the Build ng Inspector will ~ssue a Budding Permit to the opphcont. Such perm shall be kept on the premises available for inspection throughout the work· e No building shall be occupied or used in whole or in pa rt for any purpose whatever until o Certificate of Occupanc 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 th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lows, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, os herein describe~ The applicant agrees to comply w~th all opphcoble laws, ~rdmonces, building codei housing code, and regulations, and ,~t authorized inspectors on premises and in buildings, for necessary ~ctions. ;'"~""~'"~'~,.~' ' ....... ~i'~;;~hre of applicant, or n~'~"~';~';~;~'i ....... (Add~ess o~ applicant) // ~ ~ State whether apphcant ~s owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises ......... ..~....~.. ..... ~,~...L...~...~.......~........~....../).../~../...~.. ,....'~.....E~..~....~.. .............................................. If applicant is a corporate, s~gnature of duly authorized officer (Name and t~tle of corporate officer) Budder's License No .................................................... Plumber's bcense No ................................................. Electrician's License No ............................................. Other Trode's License No. -- '" 1. Location of land on which proposed work will be done Map No · . .......... >....~.~..~ ................. Lot; No ....................... Street and Number ....................... .~,~.,~...,.~,,.~...L.Z'.. ....... ,.]'r,.~..,/~...,L'~', ............. ..J~....~.,..~.!..T.,?.c...~,,, ......... ../~..:..~.. .............. J Municipality State existing use and occupancy of premises and intended use and occupancy of proposed cat, situation: a Ex,siting use and occupancy ................ ,,/,.,..,~,,.~..,../~./..! .,/'-.~,/' .......... .~..~.V',,../..~...Z:.~..,,J.,,A/,. ~ ........................................ b, Intended use and occupancy ....... ..~..,~..../?...~.- ........ ...~../.. ,.~.......J~.. ...... Zz)t ....... ..j~'...L.~...~/..~..L'·~.. .................................. 3' 'Natttre of work (check which applicable)' New Budding .................. Addition ............... Alteration .......... Repair .................. Removal .................. Demolitian .................... Other Work ..... ~.Z...~....../~....~.. ~..~ ..... (Description) 4, Estimated Cost ......................................................... Fee ............................................................................. (to be paid on fihng this application) 5. If dwelling, number of dwelling units ......... ~ ............... Number of dwelling 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 existing structures, if any: Front ............................ Rear ................................ Depth ................... Height ........................ Number of Stories ..................................................................................................... Dimensions of same structure with alterations or addmons Front ................................... Rear ................... Depth ................................ Height ........................ Number of Stones ........................... 8. Dimensions of~ent~e new construction: Front ................................. Rear ........................... :Depth · Hmght ..... .~. ...... .~... Number of Stories .................................................................. [/2'"'" oc:'~f De~th ~'~c ~--S-~ 9,, S~ze of~ lot: Front ........................................................ Rear 1~) Date of Purchase ........... ~./.~........~. ..... ./....~..~..-~.. Name"~"~ ........... "~ ..... ~ ........ ~' ~'~z~'~"~.~'~'~&~7~ ....... ' o ormer uwne .............................. ..-m. ....... ..., . 11. Zone or use district in which premises are situated ~:'--~'! Z) - ~ ~4 ]1~ 1 ' 12 Does proposed construchon violate any zomng law, ordinance or regulation ............. ../~.....~. ......................... 13. Wdl lot be regraded ............................ Will excess fill be removed from premises' ( ) Yes ( ) No 14 Name of Owner of prem,ses ..~...K.....~....~.. ....... ...'~....~-..J..~. .......... Address ................................ ~'none ~o .................... Name of Architect .............................................. Address ................................ Phone No ...................... Name of Contractor /4,f ~'/~ ~H ~, Address ................. : .............. Phone No ...................... PLOT DIAGRAM Locate clearly and d~stmctly all buddings, whether ex~_~hng or proposed, and md~cate all set-back dimensions fron property hnes. Gwe street and block number or description according to deed, and show street names and ind~cat: whether interior or corner lot. STATE OF NEW YORK, ~'~/F(;'~[C ¢ COUNTY OF .............................. .......................... ............ .../...~....~...?. .................. < being duly ~worn, deposes and says that he ~s the apphc~.q (Name of individual signing contract) ' above named He is the ............ .~.....1~...../~....~..~....~. .......... '('~'f~r~i"~'~'~',' ~'~c~'~)~'~'~'r',"~')' ............................................... of sa~d owner or owners, and ~s duly authorized to perform or have performed the said work and to make and ill.' this application; that all statements contained ~n this apphcat~on are t~ue, fo the best of his knowledge and belief, an[ tha~ the work will be performed in the manner set forth in tk, e apphcahon filed therewith. Sworn to before me thru ................... , Notary Publ,c~~_~...o~. _~~. ....... So~nty ............... ~ ..... ~ .................................. ~/ ' ' .... ' (Signatu~' of applicant) JUDITH T BOKEN Notaw Pubhc, Slate of New Y~rk No, 52-0344963 Suffolk Ceunt~M),f~' ~ommi~,s~on Expires March 30,