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Home My WebLink About6615-z FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT 'TOWN CLERK'S OFFICE SOUTHOLD, N*. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6615 Z Permission is hereby granted to: l~' & Mrs T, W, Young Village La Orient ":; ....................................................... erect and maint & rail OR post & board fence ~0" h~ h ~/ .~ ~o .................................................................................................................................................. g,... D~ at premises located at ............................................................................................................................ Orient N.Y. May 30 pursuon~ ~o opp~ica~ion doled ....................................................... , ] .... , omd opproved by lhe Building Inspector. 15;, O0 Fee $ ........................ FOI~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ^ppraved ........................................ , 197-- Permit No. D~sapproved a/c ............................. Application Date [vi~.¥ 30 19...?.~.. INSTRUCTIONS a. Thais apphcat~on must be completely filled ~n by typewriter or in ink and submitted in triplicate to the Buildi~ Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule b. Plot plan showing location of lot and of buddmgs on premises, relationship to adloming premises or public streets. areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this apphcatio, c. The work covered by this application may not be commenced before issuance of Buildmg Permit. d. Upon approval of this apphcation, the Budding Inspector wdl ~ssue a Buddmg Permit to the apphcant Such perm shall be kept on the premises available for inspection throughout the work. e. No budding shall be occupied or used in whole or in part for any purpose whatever until a Cerhficate of Occupan, shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuQnt to t~ Building 7one Ordnance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances, Regulations, for the construction of buildings, additions or a~terot~ons, or for removal or demolition, as herein describe, The applicant agrees to comply w~th all applicable laws, ordinances, building code, housing code, and regulations, and i admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of appl~/cont, o~name, if a corporation) (Address of applicant) State whether opphcant is owner, lessee, agent, architect, engmeer, general contractor, electrician, plumber or builde Ckc~e z' Name of owner of premises ~..~.~..~(.~.~..~..~....~;~..~;..~.~...~.~..9.~..5-...~..e..~..~..~....z:~..~ ......................................................................... If applicant ~s a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................ Other Trade's L~cense No ............................................... 1. Location of land on which proposed work will be done, Map No · . ..... ~ ......................... Lot No ...... ~..-~... ......... Street and Number ..... ,.~../.~....~..~..]:.Z..~g..e...~.~e. ............. .0~?.1.~ ....................................................................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a Exis,ting use and occupancy ....b..~..s..~...~..e..s...s....lg...-g..~..~..~..J..!5.~...-....~.t;.g.~.~. ........................................................ b Intended use and occupancy ........... ~.~...~..e.....~...~.~ LPeztoe 3. Nature of work (check which apphcable). New Budding .................. Addition .................. Alteration ....... Rep(Jir .................. Removal .................. Demoht~an .................. Other Work ........ ~.e.D..q .e. ................. (Description) 4. Estirnated Cost ............................................................ Fee .~.,.~.~..0...0. ................................................................ (to be pa~d on filing this apphcation) 5. If dwelling, number of dwelhng units ............................ Number of dwelling umts on each floor ................... If garage, number af oars ............................................................................................................................. 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 add,hans' 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 .... ~.~ .............................................. Rear ............ .~..8. ...................... Depth ... 1.~.~ ........... 10. Date of Purchase .............................................. Name of Former Owner ................................................ 11. Zone or use district in which premises are situated ............. .~..-...'l ...... .b...~.~.~..~..e..~ .................................... 12 Does proposed construction violate any zoning law, ordinance or regulation ......... ~..O. .................................. 13 Will lot be regraded .........~..~ ............... Will excess fill be removed from premises. ( ) Yes ( ) No 14 Name of Owner of premises ....~.....~.'i].]~.~...~.~l~g...~C..]k(~,zD~Jdress ................................ Phone No ...................... Name of Architect ................................................ Address ................................ Phone No ...................... Name of Contractor ....... .s..~.~..e.. ................................... Address ................................ Phone No ...................... PLOT DIAGRAM Locate clearly and d~stmctly all buildings, whether exi, tmg or proposed, and red,cate ail set-back dimensions fror property lines. Gwe street and block number or descnpt*on according to deed, and show street names and ind~cat whether irterior or corner lot. STATE OF NEW YO~I¢,, ,, t ~ ~ COUNTY OF ....... ~.Z~.z...O.;!.~ ....... [ ~.~ ................................ ~o:D~'t.....¥Q~.z12~§ ........................... being duly sworn, deposes and says that he ~s the apphca (Name of ~ndw~dual s~gnmg contract) above named. He ~s the . ......................... 0.I~'1,f~ .................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized ta perform or have performed the sa~d work and to make and f, th~s applicahon; that all statements contained ~n th~s apphcatlon are true to the best of h~s knowledge and behef, a, tha~ the work wdl be performed m the manner set forth ~n the apphcat~on filed therewith Sworn to before me this .................. ...................... ........... Notary Public, . ................................................... County ....... z ............ (Signature