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Home My WebLink About6665-z FOI~M NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT! TOWN GLERK'S OFFICE SOUTHOLD, N~. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ; N? 6665 Z Permission is hereby granted t'L___ ...... .................. /..~..~....~.~.~.~.....~. · .............. z-~.~..~..,...~....~ .............. ~ ,~... ~ .z:..~..,¢..~.~ ........ .,,~...~.. ....... ~.~ ...... ~...,Z~.~.......-.. ...... ~,~..~z:...~.~. ..................... at prem ses 'ocated at ..../.~..~..'(..~. :...~Z~....~,.~.....: ....................................... /...~.c . ........ ~ ............................ : .......... pursuant to application dated ... ~'../..~..~..../...~: ........ i....., 19....~,.., and approved by the Building Inspector. FOI~M NO. 1 TO~N O~ $OUT~OLD BUILDING DEPARTMENT~ TOWN CLERK'S OFFIGEi SOUTHOLD, N. Y. Examined ~(~/' / ~-~ ~ ~ ......................................... 19..~. ................ ...... , .......... ~opprove~ ~/c ............................................................................................ ( ui din~ Inspoctor) Application No. '~d E'J APPLICATION FOR BUILDING PERMIT Date ............................................... 19 .... INSTRUCTIONS a. This application must be completely filled in by typewriter or~ in ihk and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according f~o schedule. b. Plot plan showing location of lot and of buildings on premises, relatidnship to adjoining premises or public streets or areas, and giving a detailed description of layout ofproperty must be drawn ~n the diagram which is port of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue ~ Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in pa rt for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building inspector. APPLICATION IS HEREBY MADE to the Building Department for the iissuonce of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or ~or removal or demolition, os herein described. The applicant agrees to comply with all applicable lows, ordinances, build~.j~ode, housing code, and regulations, and to admit authorized inspectors on premises and in. buildings for neces~r¥~[n~t~:~s. / ~ - (~ddress of applicant) Sta~e whether applicant is owner, lessee, agent, archifecf, engineer, gener~l contractor, electrician, plumber or builder. Name of owner of premises If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ................................................... Plumber's License No ..... ./~../(Z .......................... Electrlc,ans L,cense No....~'.'./J..~ ............................. Other Trade s License No ....... ./'.4~..../../. ......................... Location of land on which propos.e._dwork will be done. Map No.: ...~ ..................... Lot No ......................... Street and Number /(~'~ ~'('J ~/~....~?.//~/ ./.'.~..~.. . Municipality 2. State existing use and occupancy of premises and intended use andi occupancy of proposed construction: a. Exisiting dse and occupancy ~/'~;'~/~"~)'"" b. Intended use and occupancy (J')~""/Nt 3. Nature of work (check which applicable): New Building ..~ ............... Addition .."..~... Alteration ................. Repair .................. Re~,~;al .................. Demolition .................... Other Work .................................................... ~- , -. (Description) 4. Est mated Cost ~' /~/'~ ' /,~ ~ (to be paid an 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, specj, fy ~nature and extent of each type of use .~.~.~ 7. Dimensions of existing structures, if any: Front ........~...~. .............. Rear ..... ...~....~..! ................. Depth .~....~. ............ Height ....~...! ........... Number of Stories ....... L ...... J. ............................................................................................... I Dimensions o~f~same structure with alterations or additions: Front ..... ~ ........................ Rear ..~.'..~.! ................ Depth ....... ~.1~. .................. Height ......c~....~... ................ Number of Stories ...... (~ ......................... 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ..................................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 6'/.. '" 10. Date of Purchase .........../~.~i ................................. Nome 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 .......... ,,/~,,~O,. .......... Will excess fill be removed from premises: ( ) Yes (~<) No a f ne f re I,',/~Otj ~.(.;.~.~ ~,-~z~-~/~/,'/~ ~ 14. x~ me o Ow re p roses .......... '1' ...... ........... Address ........~.:..I.......!..~.~..... Phone No.~?...'~.....'?_..~...!.:..~ Name of Architect .............................................................. Address ................................ Phone~ No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly oil 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 whether interior or corner lot. STATE OF NEW~YO~,I~, t c ¢ COUNTY OF ...:.'."m~....."~.~..Xh.<, ........ ........................ ~..~ ............ ~,, ~.~ ................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contracf) above named. He is the ............. ~.~..~%.~ ...................................................................................... (Contractor, agent, corporate officer, etc.) ........................................................ of said owner or owners, and is duly authorized to perform or have performed the said work and to make and this application; that all statements contained in this application are true to the best of his knowledge and belief; and thor the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ' Notar ubhc, Co , TERRI LEE NOTARY pUBLiC, State of New Yolk