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Home My WebLink About6976-z FO~M NO. 2 TOWH OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6976 Z Date ................... ?/c~be~. ....... ~ ....... , 19...~.3. Permission is hereby granted to: F~u4~z~.. ~.ea~s~,~ ............................................... ..... ~s~ar~..~- .............................................. ........ ~h~.l~..t.uck ............................................... ~o ...;~,~td .... ~.ar...~a~d~..I;exm.a ................... at premises located at ..... Lo:~...~ ....... ~a~;l~,~'~.~[..~a~Tz~:;g .................................................................. ................................................ E~t~a~d..Ct ............. ~t.~t~ACk ................................................. pursuant to application dated .............................. N~V. ...... ~ ......... , 19..~.~.., end approved by the Building Inspector. Fee $~ 5~.0~ ............. ' .........~-:~' '~"~"Bud~'~'Lg ............ I~r'~'" ¢''~ .................. Examined ............ ....~... ?.....~........~......., 192...~,., Approved FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. Disapproved a/~.-...~.f.~,.;.:.....~ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Thru applicat.on must be completely filled ~n by typewriter or' ~n ink and submitted in triplicate to the Buildin Inspector, w~th 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing Iocahon of lot and of bud&ngs on premises, relationship to adlmmng premises or public streets ¢ areas, and giwng a detmled description of layout of property must be drawn on the diagram which is part of this applicatior c. The work covered by th~s application may not be commenced before issuance of Building Permit. d. Upon approval of th~s apphcation, the Building Inspector wdJ issue a Budding Permit to the apphcant. Such perm shall be kept on the premises available for inspection throughout the work. e No budding shall be occupied or used ~n whole or in part for any purpose whatever until a Certificate of Occupanc shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Budding Department for the ~ssuance of a Building Permit pursuant to th Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances · Regulations, for the construction of buddings, addmons or aJterat~ons, or for removal or demolition, as herein describe~ The apphcant agrees to comply w~th all apphcable lows, ordinances, budding code, housing code, and regulations, and t admit authorized inspectors on premises and in buildings for necessary inspections. ...... (Address of applicant).4z~r/~,-,~ State whether opphcont is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde ...................................... .(2.. ./&. ........................ If applicant ~s a corporate, s~gnature of duly authortzed officer. (Name and title of corporate officer) Budder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Zrade's License No ............................................... ~.~T.... L 1. Location of land on which proposed_work will be done,,~Map No ..... at No ....................... Street and Number ....... Municipality 2. State existing use and occupancy of p,,~m~ses and intended use and occupancy of proposed construction: a. Exis.ting use and occupancy...~.~.~ ..... ~,~..~ ............................................................... b Intended use and occupancy ................. .~...k .......... ~.~....~...~ ............................................... Nature of work (check which applicable). New Building .................. Addition ":"A~---~___/~Alterati°n .... . . Repair .................. Removal .................. Demolition .................. Other Wa rk (,. ' ./~'.. &-'~/M(,~.~...'.~. fr.. rD.l~..~....../~ "-- -- --(DescFiptiorg 4. Estimated Cost F__/,][] Fee ....................................................................... (to be paid on filing this apphcat~on) 5. If dwelling, number of dwelling units .........................Number of dwelhng umts on each floor ................ If garage, number of cars ........................................................................................................................... 6. ~f 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 additions: Front ................................... Rear ........... Depth ................................ Height .......................... Number of Stories ............................. 8 Dimensions of entire new construction: Front .................................. Rear .......................... Depth ............ Height .................... Number of Stories ...................................................................... 9 Size of lot. Front ............. ./'..~.~. / /' ' ""' ................................ Rear ........ ./..~.~ ................ : ..... Depth..~c..'~'~. ......... _ . 10. Date of Purchase ....... .~....~:Z'. ...... .~....~. .................... Name of Former 11 Zone or use d~strict in which premises are situated ............................................................................. 12 Does proposed construction wolate any zoning law, ordinance or regulation' . ..... /~..~ ...................................... 13 Will lot be regraded ............................ WHI 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 d~stmctly all buildings, whether ex~sting or proposed, and ~ndicate all set-back d~mens~ons fron property lines Give street and block number or description according to deed, and show street names and ~nd~cat, whether inierior or corner lot STATE OF. N EVj6~OJi~.,//~ t ¢ ¢ .................................................... :-.7.7...~:~... .............. being duly sw~rn~ d~oses ~nd soys thor (Name of ind~wdual s~gmng contract) above named. He ~s the ........................................... ~ ................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and ill. this apphcat~on; that all statements contained ~n th~s apphcation are t~e to the best of his knowledge and behef, an~ thor the work will be performed m the manner set fo~h in the apphcation filed therewith. Sw.~ ~.~..t.~. b e f .~ e t ho~ ..... ~~-. ..... , 19~~ ~ ..... · ................. o, ..................... JUDITH T BOKEN NoI~ Public, Slat~ of Ne~ York No. 5~-O34496~ Suffo~k Count~/ ¢o~i~ion [xplres M~rch 80,