The URL can be used to link to this page

Home My WebLink About6566-z ~ORM NO. 2 TO~VN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, Iq. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE ~/ORK AUTHORIZED) N? 6566 Z Permission is hereby granted to: Dote ....................... ~ ......... 10 ............ 19'73" Building tnspectc~ / TOWN OF SOUTHOLD ~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Disapproved a/c . ........ ' ' '~~;i ............. APPLICATION FOR BUILDING PERMIT~/,,~ Dote ..~..../,~..~ .6'/..,,~,.,.~,, ........ i 9.?.~. INSTRUCTIONS a. This appfication must he completely filled in b~ ~rit*r or in ink ~nd ~ubmi~d in tri~limt* to the Building lindner, ~ith ~ ~t~ of ~len~, ~uret~ plot plan to *~1~. ~ ~rdin~ to ~hedul~. b. ~lot plan ~ho~in~ Io~tion of lot ~nd of buildin~ on ~mmi~*, rel~tiomhi~ to ad[oinin~ ~remi~ or ~blie ~t~ or ~re~, e. T~ ~o~ ~red ~ thi~ ~plimtion ma~ not ~ comm~nmd ~fore issu~n~ of 8uild}ng Permit. d. ~n ~m~l of thi~ ~li~tion, the 8uildin~ In~etor ~ill issu~ ~ 8uildin~ Permit to the *~pli~nt. the ~mmi~ ~il~le ~r in~ion throughout the ~ork. *. ~o buildi~ th~ll ~ ~pl~ or u~d in ~hole or in ~ for an~ pur~ ~het~r until ~r~n~ b~ t~ 8uildin~ In~tor. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuent to the Building Zone Ordinance of the Town of Southold, Suffotk County, New York, and other applicable Laws, Ordina~cas or Regulations, for the construction Of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable law~ ordinancas, building code, housing code, and regulations, and to admit authorized inspectors on premiss and in buildings for necessary inspections. _ .......... - / (Signature of applicant, or n~me, if a corl~r'ation) {,~:ldress of a~lic~nt} Slate whether epplicent is owner, le~e, e~nt, emhitoct, engineer, ~neral contrector, elt~:rieien, plumber or builder. Name of owner of premises ...... '...: ........... ~.....,.~,..~..~.....~ ....... If applicant is a corporate, signature of duly authorized bfficer: ...~..~ ...... ~....~....~.,. ..... ~.......~,.-%.....~.x.~{~.....~.~..~.~.~,~m (Name and title of corporate officere~ Builder's License No .......................................................... Plumber's License No ......................................................... Electrician's License No ..................................................... Other Tr~le's License No ................................................... I. Location of land on which proposed work will be done. Map No .............................................. Lot No ......................... - ~. Street and Number ............ ~..:.~,...~.~. ........... .................. ....................... ................................................ Municipality 2. Slate existing use and occupancy of premises and intended use and occupancy of proposed construction: aExistin usean n .~.~ ..~.~ .... ~ ~-/_~c,~.J /.*~.,,.~ · d upa ....... ................ ............ .C ......................... ............................. b. Intended use end o~upan¢¥ ................. ~:..~..?...:.~ ~, ........................... *'* ..../~... .... Addition ..................... Alteration ...... :..~ .... 3. Nature of work (check which applicable): New Building ................. Repair ......................... Removal ......................... Demolition ........................ Other Work (Description) ~ 4. Estimated Cost'. .............................................. Fee ....~ ............................................................................................ (to be paid on filing this 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 nature and extent of each type of use ..................................... 7. Dimensions of existing structures, if any: Front .....................Rear ........................... Depth ................................... Hight Nu bar 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 .......................................... Depth .................................................. 10. Date of Purchase ..................................... Name of Former Owner ............................................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does i)roposad construction violate any zoning law, ordinance or regulation: ...... ./~'. ~ ............................................... 13. Will lot be recjraded .......... ~ .......... ~.. Will excess fill be, removed from~l~emises: [. ] ~Yes [ ] No 14. Name of Owner of premisas~Z'~..~...~.-..~.;.~....~..~ ....................... ~...~:::;~.~...c......~.. .............................. (Address) (Phone No.) Name of Architect ..................................................................................................................................................... (Address) (Phone No.) ... Name of Contractor ................ -~ ..................................... [~'e~')' .......................................................... (Phone No.) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from' property lines. Give street and block number or description according to deed, and show street names and indicate wheth- er interior or corner lot. STATE OF NEW Y~0_R K, ~,, ) COUNTY OF ...... ...~--~.~..~..~.~.~, .................. ) SS ................. ..~..~.~,.~-~.......~..;.....~...~%..~..~.~..(~ .................. being duly sworn, deposes and says that he is the applicant above named. (Name of individ~ si~ing con~ct) He is the ................ ~.~~ ........................................................................................................................................................ { Cont~ctor, a~nt, co.rate officer, etc.} of said owner or owners, and is duly authorized to ~rform or have ~rformad the said work and to make and ilia this a~lication~ that all statements contained in this a~olicafion are true ~o tbe best of his knowledge a~d ~lie~: and that the work will ~ ~rform~ in the ~nnsr se~ forth in the aOOHcafion filed ~hera~th. ...................................... NOTF.; · = MONUMENT SURVEY FOR CHESTER ~ CIAGLO~ 8~ ANTOINETTE A ClAGLO LAUREL TOWN OF $OUTHOLD SUFF. CO, N.Y 'GUAR~t'~EO TO= ~v~ ' ~ ~/ ~E~T~q L. ~A~O AND DEC AND