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Home My WebLink About6955-z FO~[ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWlq C:LERK'S OFFICE SOUTI~OLD, Iq. ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6955 Z D~te ........................... .~$..._. ..... .g~ ...... , Permission is hereby gr(~nt~Oa~..~4~., .................................. .~tchogua ......... ~,X, .......................................... : ......................................... Building Inspector. / I / ~/ t ~1 ~/ /r) J~::~ ~(~f/~.~// ' '- Building Inspector_ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL i [ ] FIREPLACE & CHIMNEY DATE y~/~/~ INSPECTOR _ ~///~~ roved FOElI~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ......................... .................. APPLICATION FOR BUILDING PERMIT Date ....... ~.2.,.~.... ............. 19..~...~ INSTRUCTIONS a. 'l'hm application must be completely filled in by typewriter or ~n ink and submitted in triplicate to the Bull, Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing locohon of Jot and of buildings on premises, relationship to adjoining premises or public streel areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this applicol c. The work covered by this opplicahon may not be commenced before issuance of Building Permit. d. Upon approval of th~s application, the Budding inspector will ~ssue o Budding Permit to the apphcant Such pe shall be. kept on the premmes available for inspection throughout the work. e. No budding shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occup, 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 Building Zone Ordinance of the Town of Southold, Suffolk County, New )'ark, and other apphcable Laws, Ordinano Regulations, for the construction of buildings, additions or aJterahons~4:or remo, y~al or demohtion, as herein descri The opphcant agrees to comply with all apphcable laws, ordinances/bu)fd~ng coc~,/hous~Tjg code, and regulations, an admit cluthorized inspectors on premises and in buildings for n~ inspect~s~ b (St~ ~ ap~lc~r ~ if a corporation) ................................ .... / (Address of appl~ont)~ Store whether apphcont is owner, lessee, ogent, orchitect, engineer, general comroctor, elec}nc~on, plumber or bui ........................ ........... , .............................................................................................................. o, .......... C Z.s.e.l ..... ............................................ If apphc~nt is a corporote, s~nature of duly outhorixed officer. (Name and t~tle of corporate officer) Builder's License No ..................................................... Plumber's L~cense No ................................................ Electrician's License No ............................................ OIher Trade's k~cense No ............................................... 1. Location of land on whlchzgf-Ol~s_~d wqrk.._~iktzb~t done. Map No ...,~..~. .............. . ~'~.. Lot No ................. Street and Number .../~....~..~........~5/.../....~..~....~..//-~..c~.~ :.....~....~.~. ..... ZC/.~... ........(.~/~,.Z~.~.~.c.~.~..G../~u~' 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction. a. Exis~ting use and occupancy ............................................................................................................ 5 ~ od~~. ~ b. Intended use and occupancy ..................... z ....................................... ~' ............................................. 3. Nature of work (check which opphcoble). New Building Repair .................. Removal .................. Demohtian .................... Other Work ............................................ 4 Estimated Cost ........../.~..~'f / ~_.~..~ (Description) .......................................... Fee ............................................................................. (to be prod on filing th~s apphcat~on) 5 If dwelling, number of dwelling units .......................... Number of dwelhng units 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, if any: Front ............................ Rear ................................ Depth .................. Height ........................ Number of Stories ................................................................................................. D~mensions of same structure with alterations or additions: Front ....................................Rear ....... Depth ............................. Height ......................... ~ I~lumber of Stories .............................. 8. Dimensions (~v,.entire new construction' Front ........ /..~) ........................ Rear ..... /....~. ................ Depth ....~ . Height ....... ~t ........... Number of ~'toCes ........................................................................... 9 S,ze of lot Front ......... ?~,?....~....~.. ~....../.~..C. ............ Rear ......................................... Depth ........................... 10 Date of Purchase ........ -'~'-:~.t/..-).,~......' ........................... Name of Former Owner ,~, 1 1 Zone or use district in which premises are situated ............................................................................................. 12 Does proposed construction violate any zoning law, ordinance or regulation ........ ~.....'.~. .................................... 13 Will lot be regraded .......................... Will excess fill be removed from premises' ( ) Yes ( ) No 14 Name of Owner of premises .................................................... Address ................................ Phone No ....................... Name of Architect ......................................................... Address ................................ Phone No ....................... Name of Contractor ....................................................... Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ex,sting or proposed, and red,cate all set-back dimensions frorn property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW,,-M~R~, /~ I'S S COUNTY OF ..,~::b--"~...././,~..~:~ ...... [ ~ ............................ -~/../~...'~r:~.....c~......./....~~ ................ be,ng duly sworn, deposes and says that he ,s the aopl,can, (Nam~ ~f mdiwdual sigmng contradt) above named. ,~ ~ He ,s the ................................ ~...~....~ .............................................................................. .......... (Contractor, agent, corporate officer, etc ) of said owner or owners, and ~s duly authorized to perform or have perfo_Er0~rd the sa~d work and to make and file this applicahon; that all statements contained m th~s apphcation are t.,r.,cr~,'jlro the best of his knowledge and behef, and that the work will be performed in the manner set forth in the applica~j;r~led tJ~ew~th/ Sworn to before me this . /// // ~ .............. '-Z: ...... ......... , // X'7/ ............ /./ (,,'S'ignature of .~licant) No 52-03~4'~6d Su~%lk C~.L~'~ Comrmss~on Exl;tre~s March 30 19F,~