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Home My WebLink About6913-z FOl~lt{ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTJ~ENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6913 Z Date October Permission is hereby granted to: ...... ~:.~.'. ........... .(..~~..~.~.~ ........... ............. ~,~t,. ............................................ Bund a~ addition & ~mkm ~tlterat~o~ on e~$~;~hug d~e;l~ng ....~..,~...?.~L~,~.~ ........................................................................................... at premises located at ..~.../..~......~.....-~......~...~....~. ........ .~.~..h...~ .~....} ................................................... {~ree~l~o:rt ti,~, · ($ou~holtl pursuant to application dated ...................... '....,.~..~ ....... .1IQ ........... , 19..~.3.., and approved by the Building Inspector. ~ FOKM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ..... ~..'~......~..~ ........... , 19..~....~... Approved ............~ ........... ~. ............ , 19..~[~. Pemi~ No....~..~..(....~...~ ....... Disappr~ed a/c ................. (Bu~ ~nfl nspector) Application No, ...~...~..LJ ............. APPLICATION FOR BUILDING PERMIT Date ................... ~.~......../..~! ....... , 197....~... INSTRUCTIONS a. Th~s application must be completely filled m by typewriter or ~n ink and submitted ~n tnphcate to the Budding Inspector, ~ 3 sets of plans, accurate plot plan to scale Fee according to schedule b. Pict plan showing location of lot and of buildings on premises, relationship to adjoining pr~m~ses or publm streets or areas, g~ving a detailed descr~ption of layout of property must be drawn on d~agram which ~s part of th~s apphcation. c. The work covered by this apphcat~on may not be commenced before ~ssuance of Budding Permit d. Upon approval of this application, the Budding inspector will ~ssue a Building Permit to the applicant Such permit,shall be kept the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or In part for any purpose whatever untd a Certificate of Occupancy shall have b granted by tile Budding Inspector APPLICATION IS HEREBY MADE to the Budding Department for the issuance of a Building Permit pursuant to the Budding Z, Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances or Regulations, for the constructlo, buildmngs, additions or alterations, or for removal or demolmon, as hereto described The apphcant agrees to comply wroth all apphcable la ordinances, braiding code, housing code, and regulauons, and to admit authorized inspectors on premises and tn buddings for necessary inspectio State whether al ...... Name of owner If appJl~,~,, ........... (Nar (Signature of applicant, or name, If a corporation) .,. ....... (Address of apphcant) ngineer, general contractor, electrician, plumber or build ./T..z¢ ...... .................................. .......... .,..7...z..£. >...v:.. ..................................... Builder's License No .......................................................... Plumber's License No ......................................................... Electrician's License No ..................................................... Other Trade's License No ................................................... 1. Location of land on which proposed work will be done. Map. No ............................................... Lot No ........................ Street and Number ...... ~......~...~...~."..C~.. ......... ./...~'.:.~.,.~.C~.. ...... ...~....' ......... .~.~...O.?.~...O.~. .................................................... Municipality 2. State existing use and occupancy of prer~ses_,,,/,,<,_ ~ _ /q,~ . ,--a~nd intended use and occupancy/3 z-- ,-- ~, r---~,, ,~°f proposed construction: a. Existing use and occupancy ......... r/~..(."..~-.~.../.../~...U../.~/..~.~./.., ..... ~..~,.~. ........ /...~.~...O../../~:'.../.~.,.~y:.~.~,.. ......................... b. , rite, haled use and ocgu pancy .......~, ..~.~.J. ~.,:..4..~....~....~...~.. ~ ........ .~....~..,~... ...... . ./~...../~..~.. ~../~../..t?..%~.., .../~... ...... ~:~1~ 3. Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration ....... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... { DescrJphon) n. EstimatedOost ...... ............. Fee (to be pa~d on flhng this apphcat~on) 5, If dwelling, number of dwelling units ....... ~ ....... Number of dwelling units on each floor ......... i ............................... 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 .... ~,~.~...~, .......... Del)th .... ,~,~...,~, ................ Height ........................................................... Number of Stories ........... Dimensions of same structure with alterations or additions: Front ...... 9,~.....L~., ....... Rear ...... ,0,,,~.....,?, .................... Depth ...... ..~.~.....0. ........................ Height ......................................... Number of Stories ....................................... 8. Dimensions of entire new construction: Front ......................... Rear ............................ Depth ................................ Height ................................................. Number of Stories ........................................................................ 9. Size of lot: Front .,.../...~.[:3._. ....................... ........ .................. , .... Depth ...... ~...0, ................................. 10. Date of Par. chase .... ./.~...c.[.~. ...... .~../....~. ....... Name of Former Owner ............................. ~.. ........................................... 11. Zone or use district in which premises are situated ................................................................................................... 12. Does proposed constructiqn.violate any zoning law, ordinance or regulation: .......................................................... 13. Will ~ot be regraded _~./..V...~. ..................... Will excess fill be removed from premises: [ ] Yes [X]' No 14. Name of Owner of premises ..................................................................................................................................... (Address) (Phone No.) Name of Architect .................................................................................................................................................... ~ ,. -- (Address) (Phone No.) Name of Contractor ..,~ .~...; ...... i .~...[..c..%~...~,.~...~..C.;:. ......... ................................ tAddress) / {Phone No.) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions ftc property lines. Give street and block number or description according to deed, and show street names and indicate whel er interior or corner lot. / STATE OF NEW YO.J~I<, //., .// ) COUNTY OF ~"N/~/.~,.~/~ ........ ...................................................................... being duly sworn, deposes and says that he is the apphcant above na~ (Name of mdtvtdual stgntng contract} He ~s the ................................................................................................................................................................................... (Contractor, agent, corporate officer, etc.} of smd owner or owners, and is duly authorized to perform or have performed the smd work and to make and hie th~s application; statements contained ~n this apphcat~on are true to the best of ~!~)l~.n,o. wl.e~ge and belief; and that the work wdl be performed in the m setNotary Pubhc~~~Ount~'''-''''''f~it'~ ~/,n~.~ i~tld~~ f~'~d therew~~.~, 19 ' ~'-~ ~~"StZ' ..'i.i.i ...... 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