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Home My WebLink About6518-z I~ORM gO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING FERMIT CT'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6518 Z Permission is hereby granted to: ·-~,~..~..~enc~..(~o-.-.-A~/~..t~.~at~.-Beebe ............. l~.ti.t~ ............................................. at premises located at .......... ~"I~'~'"~'~'b'~'"A'~ .................................................................... ..................................................... ~[e~..f~xt'£o2k ...I~.~.. .................................................................. pursuant to application Building Inspector. Fee $'~,:~'00 .......... dated ....................... ~L~P:['t"'~6 ............... 19~.~...., and approved by the TOWN Or SOUT.OLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. DisopproYed o/c ............................................................................................ ~o,e ............... ~../..~../.. ............... INSTRUCTIONS a Th~s apphcat~on must be completely filled ~n by typewriter or ~n mk and submitted ~n trlphcate to the Budding Inspector, wi 3 sets of plans, accurate plot plan to scale Fee according to schedule. b. Pict plan showing location of lot and of buddings on premises, relationship to adlommg premises or pubhc streets or areas, ar g~wng a detailed description of layout of property must be drawn on d~agram which ~s part of th~s apphcat~on c. The work covered by th~s apphcatmn may not be commenced before ~ssuance of Budding Permit. d Upon approval of th~s apphcat~on, the Building Inspector wdl ~ssue a Budding Permit to the apphcant Such permit shall be kept the premises available for inspection throughout the work e No budding shall be occupied or used ~n whole or ~n part for any purpose whatever untd a Certificate of Occupancy shall have be, granted by the Budding Inspector. APPLICATION IS HEREBY MADE to the Building Department for the ~ssuance of a Budding Permit pursuant to the Building Zor Ordinance of the Town of Southold, Suffotk County, New York, and other apphcable Laws, Ordinances or Regulations. for the construction buddings, additions or alterations, or for removal or demoht~on, as hereto described The apphcant agrees to comply w~th all apphcable law ordinances, budding code, housing code, and regulations, and to admit authorized inspectors on premises and tn buddings for necessary inspection- (S~gnature of apphcant, or name, *f a corporation) (Address of apphca~t) State whether applican~ is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or budde ..... .......... .......... If applicapt~jis a c~rpor~e'~,ig.~e of c!uly authorized officer. .... ............................ , ! (Name a~d title of corporate officer) 1. Location of land on which,1/~, ~)~ ,/. //. z~//~. //,~ ,~' ~'~,/' .~/~1 ~-'//pr°p°sed work will be done.. Map,No.: ..... ~. .......... Lot N,o ................ ::~ ....................... Street and Number ...L .~...(2.~lT..L~.....,&.&/~..!,~..~.,~d,,,,~,,z~.c..~.P....~.......~.f,,~z~ ./b-,/~.~..~,;~.l....L..:..:..=~..__ ........... OZ~¢P J /// ~/ Municipality 2. State existing use and occupancy of premises and intended use and occupqr~c.y of proposed construction: a. Existin§ use and occupancy ......... /,...,~.~a.~.~t~..~.~..~/..~/d~.~.~'~.~,..~r..~ ............................................................ b. Intended use and occupancy ......... ~,..-~:...-,/,,..//~ ......... : ................................................................... ........................... - 3. Nature o¥ work (check which applicable): New Building ....................... Addition ..................... Alte/~at_i~n:...~.'1.,~7_ ..... Repair ......................... Removal ......................... Demolition ........................ Other Work .... v~:~ ..... / (DescrlpBon) ~ Fee ] ~,.'~'.. 4. Estimated Cost (to be prod on fmg this apphcat~i ................................ 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 occupancy, specify nature and extent of each type of use .................................... 7. Dimensions of emsting structures, if any: Front ..................... Rear ........................... Depth .................................. Height ........................................................... Number of Stories ............................................................................ Dimensions of same structure w~th 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 ...... /.~..~.2. ....................... Depth ...... /..-~.~.,....;.~d~ ............... Height .................................................... Number of Stories .................................................................................... 10. Date of Purchase ..................................... Name of Former O_wn,,~... ....................................................................... 11. 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 ~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 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 whe, er interior or corner lot. STATE OF NEW YOR. KZ/, He Is the ,, (Contractor, agent, corporate officer, etc ) of smd owner or owners, and ~s duly authorized to perform oy statements contained m th~s apphcat~on are true to the bbst of his knowledge and behef,.~d that the work wdl be performed in the n- set forth m the apphca~t~n fded therewith , .......... day of ..... 19 Notary Pubh ...~. ' ~ ~Lz(.~. ¢ ......... ,~ ................... / (Sig~fature of apphcant) being duly sworn, deposes and says that he *s the apphcant above na~