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Home My WebLink About6543-z FO~M NO. ~ TOWN OF $OUTHOLD BUILDING DI~FARTJ~ENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) N? 6543 Z Permission is hereby granted to: ~h~s..&..aat,~a~....O~o~d .................................. .................. ~¢~a~h~l~ .......................................... to ,-E~ee-t ,, _~_.4-,,~ts,!:~,.,~t e.~ie~..,~e~e ....................................................................... at premises located at ....W/J~.,~.~(~I~..J~I~ .................. , ...................................................................... ..................... · : ........................ Sou-tho3.d- ...... ~.,-¥.,. ............................................................................. pursuant to application dated .......................~{a~. ....... .~ .............. , 19..~/.~., and approved by the Building Inspector. Fee $'""t ~j'_O{D ....... Building Inspector/ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. ^pplicotion No .... ..~..,~...,~...~ ........... INSTRUCTIONS a. Th~s apphcatlon must be completely filled in by typewriter or in ink and submitted in trlphcate to the Building Inspector, ~ 3 sets of plans, accurate plot plan to scale. Fee according to schedule b. Plot plan show~ng location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, giving a detailed description of layout of property must be drawn on d~agram whmh ~s part of this application. c. The work covered by this application may not be commenced before issuance of Bulld~ng Permit. d, Upon approval of th~s application, the Budding Inspector will ~ssue a Budding Permit to the applicant Such permit ,shall be kep the premises available for inspection throughout the work e. No budding shall be occupied or used in whole or m part for any purpose whatever until a Cert~fmate of Occupancy shall have granted by ~he Budding Inspector, APPLIC,~,TION IS HEREBY MADE to the Building Department for the issuance of a Budding Permit pursuant to the Building Ordinance of the Town of Southold, SuffoJk County, New York, and other applicable Laws, Ordinances or Regulations, for the construct~. buddings, additions or alteratmns, or for removal or demoht~on, as herren described The applicant agrees to comply with all applicable ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspecti (Signature of apphcant, or name, ff a corporation) (Address of apphcant) State whet:her applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bui ............................................................... .............................................................................................. Name of ,)wner of premises ...:.~.}~ ~--'~g,.~.~....~......L!~.~...~.~.~...~.....~. ..... .~..~..~..%C~.~EL ............................... 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 Number ~.~ .~.~, '"'~' ~'~"c] '"?'~""{~'(J~/~'~'~'""}'~"*' .................................................. ':~'/_//?~ ..... ~ .............. ) (~ Municipality 2. State existing use and occupancy of p(emises and intended use and occupancy of proposed construction: a. ~i-'xisting use and occupancy .....~..~ ............ ~-f~ .................... ~. .............................................................. .,~'~/ b. intended ~Nature of work (check which applicable): New Building ....................... Addition ..................... ~Al~eration....~ ....... Repair ......................... Removal ......................... Demolition ........................ Other Work ...~..~..?_w22&~ ......... (Description) _ ../.::..:. ................................................................................. 4.Estimated Cost ....... ~...~ ............................. Fee (to be paid on filing this apphcaBon) 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 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 ................................. Heighl .............................,,,-' ..................... Number of Stories ........................................................................................ 9. Size of lot: Front ...:~.~..'..~..'~.....~. ............... Rear ..... ~..~..-..~."~...~. ................. ~pepth ..... ,/...~Z.N~..'~E?.~.~...x, ................... 10. Date of Purchase .... ~...~,/_~.~;..~..c~'-- ....... Name of Former Owner ...~..~'_~~......~...4~...~> ......... 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 __.~.~.D:~. ....... ... ........ Will excess fill J~e removed from premises: [ ] Yes-- [~ No, 14. Name of Owner of premises ....~(~.-~..~.~.~.:~L~.~l~.~.~.)..~..~O;b~..~....~.~..~.~.~.¢~,~..~.~.~.~- ..... (Address) (Phone No,) Name of Architect ..................................................................................................................................................... (Address) (Phone No.) Nam.9 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 whet er interior or corner lot. ) (Name o[ indtv~dual stgmng contract) He ~s the ......... ~ ......................................................................................... (Contractor, agent, corporate officer, etc ) of sa~d owner or owners, and ~s duly authorized to ~rform or have performed the sa~d work and to make and hie th~s apphcat~on; th statements contained m this apphcatlon are true to the best of h~s knowledge and behef; and that the work wdl be performed m the m. set forth m the apphcatlon flied therewith ~D T~ T ,~ ,-~ .............. (&gnature of apphcant) of ~1oIl ;URVE¥ FOR THOMAS R. 8~ CATHERINE AT SOUT~OLO ~ ORMOND TOWN OF SOUTH. OLD SUFFOLK COUNTY, SCALE ~ I"= 30' MARCH 21, 1972 REFERENCE: GUARANTEED TO~ USLIFE TITLE INSURANCE COMPANY OF NEW SOUTHOLD SAVINGS BANK THOMAS R. 8 CATHERINE ORMOND LAND S~)RVEYOR · N.Y.S. LIC. NO. £87P~5 RIVERHEADj_~, Y.