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Home My WebLink About6550-z ~0~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EM1SES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6550 Z Permission is hereby granted to: ~..F~k..Faa=e-.Cc,..a/.C....~g.,..J&egb~ ...... ............. ..~..¢.~.~.~.tt~ ............................................. to J~t.. ar,~!,-malJx~..~...b...£~..¢ha~t.n..~tnk...$~e..~ol...~.)...~ ~..~..~ ~t premises Iocoted ot ..... l~lOtll~...'~'~...~V.~ .................................................................................... .............................................. ~.t,~.~u~ ......... ~t ,.~.o ......................................................................... pursuant to applicotion dated ...................... Ya~ ......... 8 ........... , 19.~1.~.., and approved by the Building Inspector. Fee $-.~.~.~.(X~ .......... FOR~ NO. ! TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, FI. Y. Disopproved o/c ....... ~ ..................................... ..... ................................. ^pp,cotion No. ............. APPLICATION FOR BUILDING PERMIT · ,~. .................... 19 ....... Date ....~}f:'. ""~" ~NSTRUCTIONS a. This application must be completely filled m by typewriter or mmk and submitted m tnphcate to the Budding Inspector, , 3 sets of plans, accurate plot plan to scale. Fee according to schedule b. Pict plan showing location of Ici 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 diagram which is part of this apphcat~on c. The work covered by this application may not be commenced before issuance of Building Perrmt d. Upon approval of th~s apphcatlon, the Building inspector w~ll ~ssue a Budding Permit to the apphcant Such permit,shall be kep. the premises available for inspect~on throughout the work e. No building shall be occupied or used in whole or in part for any purpose whatever untd a Certificate of Occupancy shall have granted by the Bulldmg inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Z Ordinance of the Town of Southold, Suffotk County, New York, and other applicable Laws, Ordinances or Regulations, for the construct~o buildings, additions or alterations, or for removal or demolition, as herein described. The apphcant agrees to comply w~th all apphcable la ordinances, building code, housing code, and regulations, and to admit authonzed respecters on premises and in buildings for necessary inspectlo (Signature of appJicant, or name, ~f a corporation) (Address of apphcant) S ta~t~w.,~.ther~t is owner, lessee, agent, archi tect, engineer,i gene ra( contra cto r, el ectrician, plum her or built ....................... F_' ................. ...... _....:.._/;.. ....................................................................................... Name of owner of premises ...~::~.j ............... f~..~ ....................................................................................... ~ , f ~.s a corporate~natu re~o~u~h~ii~fficer'I! : .................. Builder's License No .......................................................... Plumber's License No ......................................................... Elec[rician's License No ..................................................... Other Trade's License No ................................................... 1. L°cati°n°f 'and°n wh, j~hprep°sedfr~?'~l be~°n'~/!aP N°~ ~- ~' ~v ............................. ~~~"-7 ........ Street and Number ~.d~........~/~..~/...¢.~......./ ...................... Z~../~-~:fr.-d[,~..~&:.~ .............. Municipality 2. State existing use and occupancy o~,~..r~mises and~ended use and occupancy of proposed construction: a. Exis[ing use and occupancy ....~__~,~c<....~c.~.~..~ .................... ,~; ................................................................. b. intended use and occupancy .................... ~ ............................. ~. ................................................................... '3.' N'atul e of'work (1check which applicable): New Building ....................... Addition ..................... Alteration...'. .......... Repair ......................... Removal ......................... Demolition ........................ Other Work ..........~ (Oescnptton) 4. Estimated Cost /5 ~) ~ Fee J ~~ (to be pa~d on hhng 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 occuoancy, 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 ......... ~..4~....4~.. .................... Depth ................ ~/../...~. .................... 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 .................................... 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 description according to deed, and show street names and indicate whet er interior or corner lot. ~ .................. being duly sworn, deposes and says that he ~s the apphcant above name taual St~l~ontract } He ~s the ........ ~ ~ .... '( ....................................................................................................... of smd owner or owners, and ~s duly authorized to perform or have performed the smd work and to make and hie this apphcation; that statements co,,ta,ned m th~s apphcat,on are true to theirS.st.tot h~ ~f~wlej~..~ and b~,ef, and that the work wdl be performed in the man set forth m the ap,phcat~on filed therewith ............... day of ......... ,.~.~ ....... 1~,-~ . Notary Pubh~~ ... ~ ountv "~..~ , ~' I'q;'~nat ..... f ann/ifant' " ) ............