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Home My WebLink About6549-zTOWH OF SOUTHOLD BUILDIHG DEPARTMENT TOWH CLERK'S OFFICE SOUTHOLD, H~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PR. EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6549 Z Permission is hereby granted to: Tet~ -'l~orlc '-F~r~ce-' ~ o · '~/~ .....~har 'les · · ~c' · ]~:~:~en O~hetto ta ...~e~..~d.,.~e.~...s ~e--~--r~- ya~"~enoe-'~'~--~'-~ ........... c~t premises I~oted at ..~t"'~...'-Pe~o~c"-~o~e~'-~- .................................................................. ............................................... ~en~.~.s..~ ......... ~~ ......................................................... pu~uant to application dated .............................~ ...... ~ ......... 19...~, and approved by tbe [~uHding In~ector. Fee $'""1'5'4'(~{) ...... Building I nsp~r TOWN OF SOUTHOLD ~/ ~ ~ BUILDING DEPARTMENT ~ TOWN CLERK'S OFFICE ~ SOUTHOLD, N. Y. ............... Disapproved a/c ............................................................................................ ........................ 'ding Inspectpr} ................................ APPLICATION FOR BUILDING PERMIT ~o~e ............... S.~ .......................... , ~..........7~ INSTRUCTIONS a. Th~s apphcatlon must be completely filled ~n by typewriter or ~n mk and submitted ~n tr~phcate to the Budding Inspector, v 3 sets of pi,ins, accurate plot plan to scale Fee according to schedule ~ b. Plot plan showing location of lot and of buddings on premises, relationship to adjoining premises or pubhc streets or areas, gwmg a detmled description of layout of property must be drawn on d~agram which ~s part of th~s apphcation. c. The w,)rk covered by th~s apphcat~on may not be commenced before ~ssuance of Budding Permit d. Upon approval of th~s apphcat~on, the Budding Inspector wdl ~ssue a Budding Permit to the applicant. Such permit,shall be kep, the premises avadable for inspection throughout the work. e. No building shall be occupied or used in whole or m part for any purpose whatever untd a Certificate of Occupancy shall have granted by t~he Budding Inspector. APPLICATION IS HEREBY MADE to the Building Department for the ~ssuance of a Building Permit pursuant to the Budding / Ordinance of the Town of Southold, Suffotk County, New York, and other apphcable Laws, Ordinances or Regulations, for the construct~, buddings, additions or alterations, or for removal or demohtlon, as herren described. The apphcant agrees to comply w~th all apphcable I. ordinances, budding code, housing code, and regulations, and to admit authorized ~nspectors on premises and m buildings for necessary inspecti, (Signature of apphcant, or name, ~f a corporation) .......................... (Address of alJpl~cant) State~ ~ _//~¢zwhether applicant, is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bull. ...... .................................................................. / ....... ........... , ........ ............................................. If applicanl is a corporate, signature of duly authorized officer. lName and title of corporate officer) Builder's License No .......................................................... Plumber's License No ......................................................... Electrician's License No ..................................................... Other Trade's License No ................................................... C.J/~-/ ~' 1. Location of land on which.proposed wo~rk will be done. Map No ......... ...~,.~..~. ........................... Lot No ......¢...:..¥:.. ..... Street and Number ....~.~.,/~..~.~...'.~... ....... ~ .......................................................................................... .J Municipality 2.State existing use and occupancy of premises aQd intended use and occupancy of proposed construction: a. Existing use and occupancy ..C"-:.-v~..,/~.~,~,/,~.,.orr/...~,~4,...~'...~'Cd,.~...~....'. ..................................................... b. Ir,tended use and occupancy ............." ~ ~.z__.J:._.~ ........... ~ ...... ~ ..... .(. .......................... .,~..27.~.~.~. ................................ Nature o,f ~vork (~heck which applicable): New Building ....................... Addition ................... ..~lteratio. n ........ ~ ..... Repair ......................... Removal .........................Demolition ........................ Other Work ~.J~,;..~?~¢-~' ............ ( D escri p~.l~n ) 4. Estimated Cost .......... ..~.~:~.;..~...~ ................ Fee .......................... L.~..,~..~)... ~... .................................................. (to be prod on fdmg this 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 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 ............ LL.,.'~.. ..................... Depth ........ L~...~.. ............................... 10. Date of Purchase ..................................... Name of Former Owner ........................................................................... 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 ~..,,4~...~ .................. Will 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 distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fro property lines. Give street and block number or d.es.c~ption according to deed, and show street names and indicate whet er interior or corner lot. _ I I ? . -- COUNTY OF ~_.,./'~.,,~'.,~.-,,-~/~ .~¢:3. ~. } ~ He IS the ............. ~~.~ ............................................................................................................ ' {Contractor, agent, corporate officer, etc ) of sa~d owner or owners, and ~s duly authorized to ~rform or have performed the smd work and to make and hie th~s apphcatmn; that statements contained m th~s apphcat~on are true to the best of h~s knowledge and behef, and that the work wdl be performed in the man JUDITH set forth m the apphcat~n hied therewith ,, . T. BOK~N ~O~ Public, Sidle o~ New York ~