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Home My WebLink About6517-z l~O]l~ NO. ~ TOWN 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) No. 6517 Z Permission is hereby granted to: ........... .... .......... ................... ~.~..::: ....... ~..:~ ......... ........................... ~::.,~......::...-.....~ ............. to ......... ~ ..........~ ............-.. ...........:: ........... ~..:.....~... ..... :.. at premises located at ............... ...~....,~...,0...: ...... ~~2:~ ...... ~.~...~.. ....................................... ................................................................................ ~.~....,..zz.~. ......................................... ............................ ~/~ ................ ./~...~...~.. ~..v.~.y.. ................................................................ pursuant to application dated ...................................... ~...~....~[, 197.,~.., ond opproved by the Building Inspector. ~ee *...1..~..~. .... Building Inspector FOR~ NO, I Approved ....................................... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ! 9..7~.. f ? 7_--- 19 ........ P~mit No ..................................... Disapproved o/c ............................................................................................ Application No ......................... (Building Inspector) APFLICATION FOR BUILDING FERMIT Date ....~..... F.~.....~,.~, .............. 1 INSTRUCTIONS a Th~s apphcat~on must be completely filled m by typewrtter or ~n ~nk and submitted ~n mphcate to the Budding Inspector, 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 adjoimng premises or public streets or areas, g~wng a detaded descript~on of layout of property must be drawn on d~agram whmh ~s part of th~s apphcat~on. c. The work covered by th~s apphcat~on may not be commenced before ~ssuance of Budding Permit. d. Upon approva~ of thts apphcat~on, the Budding inspector wdl ~ssue a Budding Permit to the apphcant Such permit ,shall be kept the premises available for ~nspectlon throughout the work. e. No budding shall be occupied or used m whole or ~n part for any purpose whatever until a Certificate of Occupancy shall have b granted by the Budding Inspector, APPLICATION IS HEREBY MADE to the Budding Department for the issuance of a Building Permit pursuant to the Building Z. Ordinance of the Town of Southold, Suffoik County, New York, and other apphcable Laws, Ordinances or Regulations, for the constructlo buildings, additions or alterations, or for removal or demolition, as here~n described The apphcant agrees to comply with all apphcable la ordinances, building code, housing code, and regulations, and to admit authorized ~nspectors on premises and in buildings for necessary ~nspect~o (S~gnature of applicant, or name, if a corporation) ......... ..... (Address of apphcant) State whether applicant is o~ner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build Name of owner of premises ...~,~,.4..~/~,:~~. ......................................................................................... If applical3t is a corporaJ~, signature of duly authorized officer. ~ I Name and t~tfe'of ~"oi~oorate officer) Builder's License No ............................................................ .-, '-z_--.-- Plumber's License No ......................................................... Electrician's License No ..................................................... Other Trade's License No ................................................... 1. ocation of land on which proposed work_ will be done. Map No ...... ...~=.../...~.~....,. .................. Lot No ......... ,.~. ......... Street and Number ..~...,~..~.~.~....,~,,. ......... Z'~.'.,~ ............ ,~.~' ............................ 2. State existing use and occupancy of premises and intended use~3nd OCCUD~a[acy of proposed construction: a. Existing use and occupancy ..... ~. ....."~~,' ..... ~-...¢..~.~;,~," ~ ~/~'~.-',~. ............................................................. b. Intended use and occupancy ................... .........'./_... ......................... .~......, ........................................................... 3. Nature of work (check which applicable): New Building ...................... ."Addition ..................... A~t~ration ............... Repair ......................... Removal ........................ Demolition ....................Other Work .... ..t¢~.....~..~ ...... (Description) 4. Estimated Cost ........... ~(',~.-.~ .................. Fee ........................ ~.__~,.~p c?~ (to be pa~d on flhng th~s apphcat~on) 5. If dwelling, number of dwelling units .................Number of dwelling units on each floor ......................................... If garage, number of cars ............................................................................................................................................ 6. If business, commercial or mixed occuoancv, specify nature and extent of each Wpe 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 ........................................................................................ Size of lot' Front Z .~..~'?. Rear .~.~. Depth ~. ~..~.~." ~.' ~.~..~.. 10. Date of Purchase ..................................... Name of Former Owner ........................................................................... 1 1. Zone or use district m which premises are situated ............. ~.. ................................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: .... .~ .............................................. 13. Will lot be regraded ............. ,-~/~'2'L ~' ..._.~._,,..,.,~:... ~1~ exces~fill I;~rer~~/-//--~ from premises: [ ] Yes [ ] No 14. Name of Owner of premises ...x~,~¢~'~ .......... ~,~-~'~¢,, .......................................................................... (Address) (Phone No.) Name of Architect .................................................................................................................................................... (Address) (Phone No.) Name of Contractor ................................................................................................................................................. (Address) (Phone No ) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fro 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 NE~O~..~. ~ ) ~ - ~ o. ' ' . ........... ~~~,~ ....... ~'~: . being duly sworn, deposes and says that he 1, the applicant above nan o~ s~d owne~ o~ owners, and ~s dul~ authorized to ~r~o~m o~u~ ~e~d the sa~d ~ork ~nd to m~ke ~nd hie th~s applmat~on; th statements contmned m th~s ~pplm~t~on ~re true to the ~~e~he~, and that the work wdl be performed m the m. set ~o~th m the ~pplm~t~on hied therewith N~ ~-~S~6~ Sulfolk Co~nl~ ~