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Home My WebLink About6403-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6403 Z Permission is hereby granted to: ....................................... ......... ~ .,...~ ~.~.~, d....~.c~..;~.~ 5~.:t .~g ............ : .............. ................. ~Lo.~.t,~ ~Zd ............................................ at premises located at ..~.;.~..,J:';~Jg,..~&O~.c~,..:~:O...~.~Z~W ....... ~ ...................................................... ................................................ ~.~ g.~ :L,"~ ],d ....... ~., ............................................................................. pursuant to application dated ......................~;,~.~' .......... .~- ............ , 19.~..~..., and approved by the Building Inspector, Fee $.'J...* .,.0. .......... ,Building Inspector[ FOP~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SouT.OLO, .. v. Examined .............. ~ .......... Z ......... , ........ Approved ...........~-- ........... -- ........... , 19 .... Pemit No ..... .~............~ .... Applicotion No..~..~.~..~..~. ................ Disapproved a/c ...... ..................... ................................. (Building I nsp(~tor) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, ~ccurate plot plan to scale. Fee accordmg to schedule, b. Pict plan showing location of lot and of buildings on premis, es, relationship to adjoining premises or public streets or areas, and,. giving a detailed description of layout of property must be drawn on d~agram which is part of this application. c. The work covered by this apphcation may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for mspectio~ throughout the work, e. No building shall be occupied or used in whole or in part 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 issuande 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~J buildings, additions or alterations or for removal or demohtion as herein described. The applicant agrees to comply with all applicable laws. ordinances, building code, housing code, and re§u~ations, m~d to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .............. ...... ........................................................................................................... Name of owner of premises .............. :~..~A~$ .......... ~.~.~.~. ........................................................... If applicant is a corporate, signature of duly authorized officer. ~ (Name and title of corporate officer) 1. kocation of land on ~hich proposed work will be done. Ma~ ~o.: ..................................................... Eot ~o: ............ Street and Number ........... ~..~ ~ ........~.1~... ~.~... ~ ........................... ~O~C~ .......... 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 occupancg .................................... ¥..../.. ................................................................................. 3. Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration ............... Repair ............. · ............ Removal Demolition ........................ Other Work .,E',,-~;t~,,.~3, ,t~,,~ ........... ......................... t Description) 4. Estimated Cost .........~.[.Q...~.o. ...................... 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 tvpe of use ..................................... 7. Dimensions of existing structures, if any: Front ....... .~ ........Rear ......... 4. ............... 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 ......................................................................................... 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 .................................. Will excess fill be removed from premises: [ ] Yes [/x~' No (Address) (Phone No.) Name of Architect ..................................................................................................................................................... lC' (A dre ~ P one o.) · ' (Address) Phone ~o./ PLOT DIAGRAM I~ocate clearlV and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from and indicate wheth- property lines. Give street and block number or description according t9 deed,and show strP~et names STATE OF NEW YORK, ~, ., ) COUNTY OF .......... , ,.~. ~.~.~.. ,~..~,.~ ........... ) SS .................. ,~ ~,'~. ........ .*,... ..~,..~,,,~.,~,,~?..~, ........... being duty sworn, deposes and says that he is the applicant above named, (Name of individual signing contractJ He is the ·...,t.~.,,,0w. ,C~.~,,L~-~,......,[~[,~. ,~,.t~..~,~.~........~'~,~.(¢3~,,,...·.,.C-,-/~.'X~-~ .................. ...~._.~,.~.~,,~, ,~.,~,~. L,,~,~.~.t~. .......................................... {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 file this application: that all statements contained in this application are true to the best of his knowledge and belief: and that the work will be performed in the manner set forth in the application filed therewith· TE~I~I LE~ £LAf( HO~AR~PUI~LIC, State of New York .............. ' '~' ' '; ' ~ ' ' 'd a V ° f ' ~"" ' ' ~" ~ 'i~i!~!~i'~5~h~'°'~; ' ¥ 9 '1'~ (~~. ~-..&~.. ~ {'~ ~(/ ~. (Signature Ol appticant!