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Home My WebLink About6880-z FOP~I NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KE/r ON THE Pg. EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 6880 Z Permission is hereby granted to: ~la,u.. G. eld j~'l,.t,h...,J;..'~ f~ ........................ .......... ~.~z..~....2.~a~h..&~.~ ................ .......... .~..~ .~..~g~'~ .............................................. ~o Build an &dd~t~on on ex~st~n~ dwell~n~ ut premises located ot ..%I:~..~.~......?..,e..IJ,.I~..J.~...A...~,.. ................ ,.~.?..t/....~..~.....~.~....t~,.. ....... .~....~.~..~.. .............. Cuteho&q;J ii,Z, pursuant to application dated .................. ,,~,,,~,~,. ....... ~ ................. 19.~/~.., and approged by the Building Inspector. Fee $...~.~...?.~ .......... But drag Inspeclr FORM NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No..~....~..~ .............. .. " " 19 0> Permit No. ~r'0c~'~) ~ Approved .................................. , ............................................ Disapproved o/c "~'Z"~ ....... ~ APPLICATION FOR BUILDI~PERMIT Date .......... '~ ....... ')- ~. ............... , 1'9~).....~..... INSTRUCTIONS a Th~s apphcat~on must be completely filled m by typewriter or m ink 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 location of lot and of buildings on prem,ses, relat~onsh,p to adlommg premises or public streets ~ areas, and g~wng a detailed description of layout ofproperty must be drawn on the diagram which ~s part of this applicotio, c. The work covered by this application may not be commenced before msuance of Building Permit. d. Upon approval of this application, the Building Inspector wdl ~ssue a Building Permit to the apphcant. 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 m part for any purpose whatever until a Certificate of Occupant shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the ~ssuance of a Budding Permit pursuant to th Building Zone Ord,nance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances · Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe~ The applicant agrees to comply with all apphcable laws, ordinances, building code, housing code, and regulations, and t admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) (Address ~f applicant) "i' c ..... State whether apphcant ~s owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or buildm Name of owner of premises If applicant is a corporate, signature of duly authorized officer. (Name and t~tle of corporate officer) Builder's L,cense No ....~.~..~..~. ................................... Plumber's License No..~..~./...'.'~.. ................................. Electrician's License No....~.~,.I...~. .............................. Other Trade's License No ............................................... 1. Location of land on whi.ch proposed.~ork will be done.,,Map No' ..~.C~ ............................. Lot No..~....-~..~i.)F~.~.~ Number Street and ........................... -~. ........................................... '/V[~'~ici~ality ,J 2. State existing use and occupancy of premises and m~cnded use and occupancy of proposed construction: a Ex,s,ting use and occupancy ..r..(~.~..i~...C~..?..!.q..~,,,..~. .................................................................................... b Intended use and occupancy ...~....~-..~...t.......~...~....~..~. ............... 3. Nature of work (check which applicable): New Building ................. Add,t~on ...J~............. Alteration ........ Repair .................. Removal .................Demoht~an .................... Other Work .................................... ?..... (Description) 4. Estimated Cost ..0...C?...~. ........................................ Fee .............................................................................. (to be paid on filing th~s apphcat~on) 5. If dwelling, number of dwelling units ......... .J ............... Number of dwelhng umts on each floor .... J ............... If garage, number of cars ...~ ................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of eczch ~pe of use ......... :~..~ ...... 7 D,mensions of,,exist,ng structures, if any: Front.....~..~.....~..-¢u~.~.:.. Rear ...,-'-~...~.....'[..~...~..~.'.. ..... Depth . ~-~.'~.. Height ./..'.~/..~.~.'.~.~.. ..... Number of Stories ...... ./. .............................................................................. ' .... Dimens,ons of s~me structure with alteratigps qr add,t~ons' Front ...... .-~....~.~.q:...~... ...... Rear .~lJ~ .' .~.'].~ . Depth .....~...~...~..~..'~.~.~) He,ght ..J'...~..2[.~..~...~.. ..... ~NumJ~er of Stones ..... J. ......... r .............. 8. Dimensions o~ entire new construction: Front ...~/~.,~/l~--" ' ............... Rear ...~X?~..~g~.-- ' ' .... Depth ./.~.Z~,~ .. He,ght ...~./~..¢.~..... Number of Stories ..~ ........... 0 ............................................. ~'. ....... , ...U... 9. Size of lot: ~ront ...... .,~..~.....~ ........................... Rear ...... ~,...~.~...~,~L ............. Depth .~,,~../'...7,~ 10. Date of Purchase ...:..m.~...~./..v....m¢. ......... N~me ,of Former Owner . ....................... 11. Zone or use d~strict ~n which premises ore s~tuated ~,-~...~.~J-¢-~..'..~.~,~..~, 12 Does proposed construction violate any zomng law, ordinance or regulation ../..~-.~. ...................................... 13. Will lot be regraded ...... /~.~...: .......... Will excess fill ,be removed from premises: ( ) Yes (V~ No 14 Name of Owner of prem,ses .~]~/.J..~.rj...J.:..(.....~..~..~..,~j./.~ ...... Address ~.,~...J~ic~/~..~.~./~/J~g'one No. Name of Architect .... ~ .......................................... Address ................................ Phone No ...................... Name of Contractor .... .~.~.~.~.. .......................... Address .~.~..~&~'~/.l~.~....'~.C'~hone No. ~.~...9[..'i..7..~...~.. PLOT DIAGRAM Locate clearly and distinctly all buddings, whether ex~.~ting or proposed, and red,cate all set-back d~mens~ons fron property lines G~ve street and block number or description according to deed, and show street names and ind~cat: whether inlerior or corner lot STATE OF NEW YORK, [ S.S COUNTY OF ............................... ~' (Name of individual s~gnmg contractO above named. being duly sworn, deposes and says that he ~s the apphcan He ~s the ................................................................................ (Contractor, agent, corporate officer, etc.) of sa~d owner or owners, and ~s duly authorized to perform or have performed the sa~d work and to make and ill, this apphcat~on; that all statements contained ~n th~s apphcat~on are true to the best of his knowledge and behef; an, that the work will be performed ~n the manner set forth m the apphcation filed therewith. Sworn to before me th~s Notary Pubhc, .................................................... County ....................................................... (Signature of applicant)