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Home My WebLink About6556-z FORM NO. 2 TOWN 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) N? 6556 Z Permission is hereby granted to: at premises located at / ~ ~9 ~) ~c/69~-r-6 ~ ~ //' A~' pursuant to application dated ~ ~'A ~/~ 19..7..'~.. and approved by the Building Inspector. Fee $.../- ."~..-C..i ...... Building Inspector SOUTHOLD, N. Y. Examined ........................................ , 19 ........ Applicotion No .............................. A"-- -~..~rove.. ........................................ , 19 ........ Pemit No ................................... Disapproved a/c (Budding Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Th~s apphcat~on must be completely fdled m by typewriter or 3 sets of plans, accurate plot plan to scale. Fee accordmg to schedule. b. Plot plan showing Iocatmn of lot and of buildings on premises, relationship to adjoining premises or pubhc streets or areas, giving a detailed description of layout of property must be drawn on diagram which ~s part of this apphcatlon. c. The wcrk covered by th~s apphcat~on may not be commenced before ~ssuance of Budding Permit. d. Upon approval of this apphcatlon, the Budding Inspector wdl issue a Budding Permit to the apphcant Such permit,shall be kept the premises avadable for inspection throughout the work e. No building shall be occupied or used m whole or m part for any purpose whatever until a Cert~fmate of Occupancy shall~have b granted by the Budding Inspector. APPLICATION IS HEREBY MADE to the Budding Department for the ~ssuance of a Budding Permit pursuant to the Building Z Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances or Regulations, for the constructio buddings, additions or alterations, or for removal or demohtlon, as hereto described. The apphcant agrees to comply with all applicable la ordinances, budding code, housing code, and regulations, and to admit authorized ~nspectors on premises and m buildings for necessary inspectic (S~gnature of apphcant, or name, ~f a corporation) (Address of applicant} State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or built ........................................... ............................................................................................................................ Name of owner of premises ~,.(.'~..~.;~.k:..~..~ ........ .~....~...o....~...c-.~...~"~.. ........ ~...~....r?../~...~..~..~...: .................................................. If applicant is a corporate, signature of duly authorized officer. ~Name and title of corporate officer) Budder's Lmense No .......................................................... Plumber's Lmense No ......................................................... Electrician's License No ..................................................... Other Trade's Lmense No ................................................... 1. Locatie, n of land on which proposed work will be done. Map No .............................................. Lot No ....................... Street a~nd Number .]...~..~.~. ....... ~..o....~..~..~...¢.....~..V...~.-~ ....... ,~/,,..~...7~.jT.~..~.~.~./..~. ........................................................... Municipality 2. State ex,sting use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...................................... : ........................................................................................ b. Intended use and occupancy ................................................................................................................................ 3. l~atut~ ef work (check which applicable). New Budxding ....................... Addition ..................... Alteration ....... . ........ Repair . ........................ Removal ....................... ..'~)emolition ........................ Other Work ~/..¢.~..~.7...5....P..~.!..T~.....~.. (Description) 4. Estimated Cost (to be paid on hhng th~s apphcatlon) 5. If dwelling, number of dwelling units .................Number of dwelling units on each floor ........................................ If garage, number of cars ............................................................................................................................................ 6. f business, commercial or mixed occupancy, specify nature and extent of each type of use ............................. ; ....... 7. D mens~ons of ex st ng structures, if any. Front .....................Rear ........................... Depth ................................... Height ........................................................... Number of Stories ....... .t ..................................................................... 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 ......J..~.! ....................... Rear ...... .~.~......~...I. ..................... Depth ...... ~..~...~.....~.......~...?..~. ............. 10. Date of Purchase ..... .'~.../.L.~.2P.. ............ Name of Former Owner ...~....~.5.J~...~..R, ........ L..~...c;...; .................................. 11. Zone or use district in which premises are situated .................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .../~g'..~ ................................................ 13. Will lot be regraded .....~ ......................... Will excess fill be removed from premises: [ ] Yes [ ] No 14. Name of Owner of premises .C.(~.h.~..~..~..~...~.~..~.~ .....,~..~Q .~..~..-~. ..... ~;~.q~.l~...~..T~..~....~.~....l~.zc~.T.q~ ...... ..~..~.~.Y..~.. (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 rrm property lines. Give street and block number or description according to deed, and show street names and indicate whet| er interior or corner lot. STATE OF NEW YORK, COUNTY OF ......................... ................................................................... 7 .... being duly sworn, deposes and says that he ~s the apphcant above name, 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 file th~s apphcat~on; 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 m the ~n~ set forth m th~, apphcat~on filed therewith r~ [[[ ~[ ..... 19 ... ................. day ~AR.~.~U~. 8tal~.bf.~ew '~ .......... ...... ....... Cou., ' .................................................... ....... ~c~ ~o, ~ ~ [Si~ature of aDDhcant)