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Home My WebLink About6542-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 6542 Z Permission is hereby granted to: ........... ~L~.~......~. ~le~. ................................ at premises located at ...~.Ii.....]~011MI~..~d:I&I~ .................................................................................. ..................................................... · mltale,l~l ......... I1.,~., .................................................................... pursuant to application dated .........................1~ ......-~. ............. , 19.~3.., and approved by the Building Inspector. Fee $.~OeOO .......... Building- ~nspector I /r '.,~'/-- " .~-- ~, /-.ZJ~TOWN OF SOUTHOLD ~-~ ~ //'" c~'~--~ ~- ~///~/J?~ TOWN CURK'S ~FICE ~ ~UTH~D, N. Y. ............... ....... ...... ' APPLICATION FOR BUIUDING PERMIT ' ~ ............. ......... ....... INSTRUCTIONS a. This epplication must be completely filled Jn by typewriter or in ink and submitted in triplicate to the Building InspeCtor, wi' 3 sets of plans, accurete plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot end of buildings on premises, relationship to adjoining premises or public streets or areas, en giving a deteiled description of layout of property must be drawn on diagram which is pert of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon epproval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit ,shall be kept on the premises eveilable for inspection throughout the work. e. No building shall be occupied or used in whole or in pert for any purpose whatever until a Certificate of Occupancy shell have beet~ granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Z6n4 Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the coflstruct[oe~ ef buildings, addltiofls or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with eli alN)gelble laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for nemssa~/inspections. .......... ..... (Signature of applicant, or n~m~eLit'~'~orporetion) ..... .... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder· ~ ~J~/.e, ~ ... ~, Name of owner of premises ~`~(~;~~w~{T~~/~/~z~ ............................................. If applicant is a corporate, signature of duly authorized officer. · {Name and title of corporate officer) 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 Numher ......... /..~...o.. ............ /.~...o...~..~.~...~.. ...... .~..~..,.2,.....~o...u.~.~..~.p.../.~....7...~..:. .............................. Municipality 2. State existing use and occupancy of premises an~J intended ps~ an.d occupancy of proposed construction: a. Existing Use and occupancy ..........v /j (~ l . //t/j Z / . ,._/___ ._'''''''''''''*'-'''''~ ................................... , ....................... .,, .................. '~3~ · ~ature of work (check which applicable): New Building ....................... Adder on ..................... Alteration ......... Repair ......................... Removal ......................... Demolition ........................ Other Work (Descd,ption) 4. g~timated Cost ............. · ....................... ~ee ...................................................................... ; .......................... (to be paid on filing this application) 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 natuyeand extent of each type of use ..................................... 7. Dimensions of existing structures, if any: Front ....... J.;: ......... Rear ........................... Depth ........ ~,..~i'...~ .................. Height ................ :/. Number of Stories .............,a ............................................................. Dimensions of same structure with alterations or additions: Front .......................... Rear ......................................... Depth ......................................... Height ......................................... Number of Stories ........................................ 8. Dimensions of entre new construction: Front ........ ~.D. ........... Rea, r .......... .(.~ .............. Depth ....... f. ........................ Hei ht ...... ~.. ............ Number of Stor es ..... ~..~ ~ ................................................................. ' - - 9. Size of ~ot: Front ........... ,Z,7..., .................. Rear ................... '~..~ .................. ueptn ........... ~'..~ ..... n ............ ~' ..... 10. Date of Purchase ......... ~.l~,.[?/.?.J--'-- ............ Name of Former Owner......~.~..J~....~.~...~ ....... 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 be removed from premise~h [ . ] Yes [ .... -- ..... ,', I1: ~ ~, ?.. .~2,,. /'(~,'V.. I.,; ~.~..~.~,.~ .... 2.~.,f...':.~.2,/...~,. 14. Name o~' uwner or premises ....w.....,, ...................... ...... ~'/~'~'~ress) ......... ~"'f~ ' iP'h'on. No.) Name of Architect ..................................................................................................................................................... (Address) (Phone No.) Name of Contractor .......................................... , ............................................ ~ ............................ [~l~'~'~;i; ....... '?~'" (Address) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proPOsed, and indicate all set-back dimensio~ from property lines. Give street and block number or description according to _deed~and show street names and indicate wheth- er interior or corner lot. STATE OF NEW y~;~K,~/ ~' ) -- ' .............................. ~t~J.~.~.~.......~_'...~... being duly sworn, deposes and says that he is the applicant above n,med. (Name oy individual signing contra~ Ha is the ................................................ ~ ...................................................................................................... ~ ................................... {Contractor, agent, corporate officer, etc.} of said owner or owners, and is duly authorized to perform or have performed the sa~d WOrk and to make and file this application; that ell statements contained in this application are true to the best o~np~,l and belief; an~l fbat the work will be performed in the manner · Nofe~y Public ' set forth ~n the a. ppl~ation filed therewith. N ' ,$iate ~ i;ew Yor~ .