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Home My WebLink About6897-z ~0~ NO, ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°. 6897 Z Date ............................................. 19..77 Permission is hereby granted ~ ~ / ~,~ , ,_~ _ .... ~_..~..~ .......................................... ,o .... ................. .... ~ ............. : ........... ~ ....... ~~ ................. ~...-/. ............................................ pursuant ,o application dated ................ ~....~.......~.. ..........., 19 ..... ...~....~, and approved by the Building Inspector. ~ee *...!..~...~ Building Inspector Approved ........................................ , ........ FOI[~I NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Disapproved a/c ~....._...._...._~....._.._.._...~ APPLICATION FOR BUILDING PERMIT Date ........ INSTRUCTIONS a Th~s application must be completely filled An 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 schedule. b, Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or pubhc streets, areas, and g,ving a detailed descnphon of layout ofproperty must be drawn on 1he diagram which is part of this apphcatlor c. The work covered by this application may not be comme~ed before issuance of Building Permit. d. Upon approval of th,s apphcahon, the Building Inspector w,ll ,ssue a Bu,ld~ng Permit to 1he 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 in pa rt 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 issuance of a Building Permit pursuant to th Building Zone Ordinance 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 apphcant agrees to comply w~th all applicable laws, ordinances, building code, housing code, and regulgtions, and t admit authorized inspectors on premises and in buildings for necessary inspections. ;, (S';g'~atu~re of ~'¥'c~"~ame, if o corporation) (Address of applicant) State whether applicant ~s owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde~ Name of owner of premises .... ~. ....~ba,,.~,~...}~-'. .............................. If apphcant ts a corporate, signature of duly authorized ofhcer. (Name and t~tle of corporate officer) / Builder's L~cense No Plumber's bcense No .............. W ........................ Electrician's License No ......... ~ ......................... Other Trade's License No ............................................... ~ ~ 1. kocahon of land on whLcL-r'~rc~osed.workxwd[ be done .Map I~: ......... : ................... Lot No .................. Street and N mb ..~-~-.~. ...~..~ ~.....'~.~.'. ...... ..~ .......................................................... //~t Municipality 2. State exist,ng use and occupancy of_pr~'~.x~,~nded use and occupancy of proposed construction: a. Ex,siting use and occupancy .... ~.....z..r ............... ~ ..... ~ ........... ~ ................................................................. b Intended use and occu anc L\ t // ~..._ //~., V 3. Nature of work (check which applicable) New Building ....~..~. .......... Addition ................. Alteration ..... Repa,r .................. Removal .................. Demolit,on ............... Other Work ............. i B'~'~'r'il~ ~ f~l~')' ' ' ' / r ............................................................... 4. Estimated Cost ................... (. ......... .~. .......................... Fee (to be paid on filing th~s apphcation) 5 If dwelling, number of dwelling units ............................ Number of dwelhng umts on each floor ................. If garage, number of cars ................................................................................................................................... 6 If business, commercial or m~xed occupancy, specify nature and extent of each type of use ................ 7. Dimensions of existing structures, Jf any: Front ........................... Rear ................................ Depth .................... Hezght ........................ Number of Stories ........................................................................................................... Dzmens~ons of same structure with alterations or addmons Front ................................ Rear .................. Depth ................................ Height ............................ Number of Stones ............................... 8. D~mensions of entire new construction' Front .................................... Rear ........................... Depth ............. Height .................... Number of Stories ......................................................................... 9 S~ze of lot: Front .................................................... Rear ................................... Depth ............................ 10. Date of Purchase ............................................. Na~e_/,~.of~. ~Owner ............................................. 11. Zone or use district in which premises are s~tuated ....... ~ .............................................................................. ~- 12 Does proposed construction wolate any zoning law, ordinance or regulation ~ ....................................... 13. W~II lot be regraded ....... ~ ........... WilJ ex~ess fill be removed frorr~pre~nlses: ( ) Yes ( .,,~No 14 Name of Owner of premlses~J~...//['..[.L..~(~. :... Address ...~..[..~..~.(.~ ........... Phone No ...................... Name of Architect ...................................................... Address ................................ Phone No ...................... Name of Contractor ..... ~ .............................. Address ................................ Phone No ...................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether exerting or proposed, and ~ndicate all set-back d~mens=ons fron property hnes. Give street and block number or descnpt,on according to deed, and show street names and mdtcat~ whether in[erior or corner lot STATE OF NEW"~/' 1, SS .................. ~.....~..~T.....; ............. being duly sworn, deposes and says that he ~s the apphcan (lqc~ of ind~wdual signing contract) above named. 7 ~~,,~,.~. He ~s the ............................ ..~.w ..................................................................................................................... (Contractor, agent, corporate officer, etc ) of said owner or owners, and is duly authorized to perform or have performed the sa~d work and to make and this application; that all statements contained ~n this (~pphcatlon are true to the best of his knowledge and behef, an, that the work will be performed in the manner set forth ~n the apphcat~on filed therewith Sworn to before me th~s ..............Notary Public, . ~,~.. day of ........... ~ ........... County' 19 '~',~/~ .~;~.~gn