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Home My WebLink About6590-zTOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6590 Z Permission is hereby granted to: ..~&~Z.~.~ .......... ~.~.~...~.~.~.~!. ........ ,o ..... ~:~..*.~C~ ................ ~ ........ ~..~.~..~:. .................................................................................. a,t premises located at ....................... ./....~....~....~. .......... ...-~....~....~C ...... ../'~....~.~ ............................................. ....................................................................... .Z..C4.s..Z. .......... /~.~.~.(..~.~ ...................................... pursuan~ to application dated ............................~...~. ....... ..~....~).....'['...., 197....~.., and Building Inspector. Fee $../..~...;~ ..... approved by the Building Inspector Examined Approved TOWN OF 50UTHOLD BUILDING DEPARTN~ENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. D~sapproved o/c ............................................................................................ (Budding Inspector) INSTR. UCTIONS a. Th~s application must be completely filled ~n by typewriter or ~n ~nk and submitted ~n trlphcate to the Budding Inspector, w 3 sets of plans, accurate plot plan to scale. Fee according to schedule b. Plot plan showing Iocatmn of lot and of buildings on premises, relationship to adjo~mng premises or pubhc streets or areas, - g~wng a detailed description of layout of property must be drawn on d~agram whmh ~s part of th~s apphcat~on. c. The work covered by th~s apphcat~on may not be commenced before ~ssuance of Budding Permit. d. Upon approval of th~s application, the Building Inspector will issue a Building Permit to the applicant Such permit,shall be kept the premises avadable for inspection throughout the work. e. No budding shall be occupmd or used m whole or in part for any purpose whatever untd a Certlhcate of Occupancy shall have b granted by the Butld~ng Inspector APPLICA ['ION IS HEREBY MADE to the Budding Department for the ~ssuance of a Building Permit pursuant to the Budding Z~ Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances or Regulations, for the constructior buildings, additions or alterations, or for removal or demoht~on, as hereto descrfbed The apphcant agrees to comply w~th all applicable la' ordinances, budding code, housing code, and regulations, and to admit authorized ~nspectors on premises and m buddings for necessary inspectio ,; (Signature of applicant, or name, if a corporation) (Address of applmant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build If applicant is a corporate, signature of duly authorized officer. IName and title of corporate officer) Builder's License No .......................................................... Plumber's License No ......................................................... Electrician's License No ..................................................... Other Trade's License No ................................................... 1. Location of land on which proposed work will be done. Map No .............................................. Lot No ........................ Street ~nd Number ..... ..~.,.~....~.~..~.~ ......... ~..~..~..~..~..~.z.~,.~'..~t~.........?.../....~...... ................................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ........................../..... · .~....~...~.~..~ ............ ~-/// .................................................... b. Intended use and occupancy ....................................... .../~...~,.z....~.... ...... ;~. ,../¢~,....~ .................................. 3. Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work ..~-...L~...~....C..~Z~.. ................... ~ (Description) 4. Estimated Cost .......?....'...~....'"' ........................ Fee ................................................................................................. (to be prod on flhng 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 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 .......................................... 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 ............ .~..~..~ ..... ..~ ...... .~WilJ, exce_~s.,fill be removed from premises: [ [ Yes [,Y~ No 14. Name of Owner of premises ~~ .'~..':~''.~:~'.~.~..~.~'d..~`~...~;~.~.~.~.~'a~.~;~~.~.~.7'~'-.~./'~?.~'~ (A~rdress) V(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 descrij~ion according to deed, and show street names and indicate whetl er interior or corner lot. ,.~ ~ .~/ ,~? /~. _.,~', STATE OF NEW YORK, COUNTY OF ......... ............ ~ "~ ..... ~.,....~ ..~~ be,ng duly sworn, deposes and says t~e ,s the apphcant above name, (Name of indtt,zdual st~tng contract) He ~s the .................... (Contractor, agent, corporate officer, etc of ~owner or owners, and ~s ~uIv authorized to ~rform or have performed the sa~d work and to make and fde th~s aBBhcation; that statements contained m th~s a~phcatmn are true to the best of h~s knowledge and behef; and that the work wdl be performed m the mare set forth m the aoohcat~on filed therewith ........... Notary Pubhc, ~~ .................. ~6~9~ 3~o~k.~9~.~ ~~~. ~~.