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Home My WebLink About6559-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~REMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 6559 Z Date ........................ I~ ............ .~ ........... ~..~. Permissmon is hereby granted to: at premises located at ....... ............................... '. .................. ...~...~.~!~ ....... ~..,X,. ............................... , ...................................... pursuant to application dated ........................... 1}~ ........... '9 ....... , 19,.:.~, and approved by the Building Inspector. Fee $..~.~* .{~0 ........... FORM NO. 1 TOWN OF SOUTHOLD TOWN CL'..<'S OFF.C' SOUT.OLD... ','. 19..,,~..,'-~. Pemit No..~..C..?..~..~. ......... Disapproved, a/c APPLICATION FOR BUILDING PERMIT Date ..... ..',~. i ...~..'. .............................. , 192..~.... INSTRUCTIONS a This application must be completely filled ~n by typewriter or In ink and submitted In triplicate to the Budding Inspector, w 3 sets of plans, accurate plot plan to scale Fee acgordmg to schedule b. Plot plan show, rog Iocatson of' lot, ~nd of bu~IdmgsL o.n prermses, _relat~o0sh~p to adjomjp~g prerms, es or pubhc streets or areas,; gwing a detailed description of layout of property must be drawn on d~agra~ which ~s part of th~s apphcat~on c. The work covered by th~s apphcatlon may not be commenced before ~ssuance of Budding Pertain d. Upon approval of th~s apphcat~on, the Budding Inspector will ~ssue a Budding Permit to the apphcant. Such permit,shall be kept the premises avadable for inspection throughout the work. e. No bm[drag shall be occupied or used m who~e or m part far any purpose whatever untda Certffmate of Occupancy shall have b~ granted by the Braiding Inspector "' APPLICAI"ION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Z. Ordinance ot 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 demoht~on, as hereto ctescnbed The apphcant agrees to comply w~th all apphcable la, ordinances, budding code, housing code, and regulations, and to admit authopzed inspectors on premises and m buildings for necessary inspectio, (S~gnature of '~pphcant, or name, if a corporation) 1 .,t,,. .... ..% ::,..:. b,..,,...u..z {Address of apphcant) State whether apphcant is owner, lessee, agent, architect, encjir{eer, general contractor, electrician, plumber or build Name of owner of premises ...,~:~.?..~..~..~,~...~..!.~21,~.?.~.'...~.,.~ ........... .~..;.~..',.~.]..~ .............................. .. ....................................... If applic, ant is a corporate, signat, wt,~of duly authorized officer. ...................................... ~"~' '~'1" .l~r; ........ ~ .................................... · (Name and title of'corporate officer) Builder's License No .......................................................... Plumber's License No ......................................................... Electnman's Lmense No ..................................................... Other Trade's License No ................................................... 1. Location of land on w~hjch proposed work will be done. Map No .............................................. Lot No ........................ ~zr~ alga i~lumDer ~.e~... ................................................................................................................................................ -- ' , .... ', Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... '~'~'i~'~'~ ..... '~:~ ....... ~'::/'~;'/'""~,'~t~; ...... [~:~'}~';'~ ................................................. b. Intended use and occupancy ................................................................................................................................. 3. Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration ............... Repai~ Removal Demolition ........................ Other Work ~ ~// C'r.~., - ......................................................... 4. Estimated Cost ........(../..~0.0.~. :...~ ................. Fee ................................................................................................. (to be prod on filing th~s 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 n~ure and extent of each type of use ............ _,. ....................... 7. Dimensions of existing structures, if any: Front .... .~.....~.. ........ Rear .... ~....~.. .............. Depth .....!...~... ....................... Height .... I..~x ................................................. 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. S, ze of lot. Front .... ~ ....... O. ............... Rear ..... ..L[_......-[. ........ .-[. ............... 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: ......... ../~....C~,. ......................................... · t be re faded J[/O Will excess fill be remove from remises' [ ] Yes [ ] No 13. Wdl Io g ..................... ~ ............ , _ ~d n p . 14. Name of Owner of premises .~'i'.~.~.~./~..~.~Ll,.c-.~-~...~......C;.'...t~....~..)( ......... .]r.£.'~.~.....~...~../'.,d~,~, ..................................... ! (Address~ (Phone No.) Name of Architect .................................................................................................................................................... · (Add_~ress) (Phone No.) Name of Contractor .l.V~.,.~.~ ..t~...~.~...,J~.9.[~.L~.,~.....~. ?d,~.~''-'-- ""' ~ - ..... L..~.~......I'...~.....~......~.~.; ....... .~..~..~...%~..-j..r.~ ............................ (Address) (Phone No.) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed,,~,nd indicate all set-back dimensions fro~ property lines. Give street and block number or description according to deed, ~ names and indicate whet~ er interior or corner lot. STATE OF NEW YORK, ) .S~ COUNTY OF .. ~'M~'~31.~.'~ .............. ) cc~d'~t] . .. be,ng duly sworn, deposes and says that he ,s the apphcant above name, He l$ the . [.'~,i[~.~td~..~,~' ..' ..~.:.~l.~,,p,.~-t~.i'..~..,..~.~;.(,..~N, ................................................................................................ (Contractor, agent, corporate officer, etc ) of sa~d owner or owners, and ~s duly authorized to perform or have performed the smd work and to make and fde th~s apphcat~on; that statements contmned In this apphcatlon are true to the best of his knowledge and behef, and that the work will be performed in the mare set forth m the apphcat~on fded therewith .... t ........ day of . ['~J..~l~. I~I'ARY Notary Public, ~. ~...'~l~..~;.l~o~my~O, tg~/~/. (Sign