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Home My WebLink About6405-zTOWN 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) No. 6~05 Z Permission is hereby granted to: ) ..~~,~~ ~..,,.~. ....... ~.~...~.~.~ ...... (~,c /xz/ , .~~~~'..~.:.~.~ ........ ....... .................................................... ................................................... ~-,.-~ ..... ~ ................................................. ,t ~,,~i,~, ~t,~ ,t ........ ~/~ ..... ........ ~ ~. ~~.z..~ ......................................... pu~uo~t to ~pplicotion d~t~d Buil~ Inspector. Fee'~/..'~.....~ .... FOB~ NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. Disapproved o/c ............................................................. Application No. ' "~lHd~n-- Inspec-or- ' ' APPLICATION FOR BUILDING PERMIT Date '~ -' r./.j~/ ~.., .... ;" ............... : ......................... , 19 INSTRUCTIONS a. Th!s .~pplication must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildina Insnectnr wit~ s~ts OT pmns, accurate plot plan to scale. Fee eccording to schedu e ° ~ - ~1 .... · Plot plan showing location of lot and of bui d ngs on prom sos, relationship to adjoining premises or public streets or area~nc giving a detailed description of layout of property must be drawn on diagram which is part of this application. c. The work covered by this application may not be commenced before ssuance of Building Permit· d. Upon approval of this application the Building Inspector w I issue a Building Permit to the applicant· Such permit shall be kel~t the premises available for inspection throughout the work· ' 1, e, No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have beer granted by the Building Inspector. . APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zon Ordinance of the Town of Southold Suffolk County, New York, and other apo cable Laws, Ordinances or Regulations, for the construction buildings, additions or alterations, or for removal or demolition, as here n described. The applicant agrees to comply with all applicable laws ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspectionsi'~ ..... (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 prem sos .*~'/~'01..,./95 ~_---, If applicant is a corporate, signature of duly authorized officer· Builder's License No .......................................................... p · ,llu rnb. er. s ,License No ......................................................... - /'~'~ ~ ectnman s License No ................. -- Other Trade's L cense No ................................... · ' .................................................. ~z'.~.-, p,,~.; -.~ · 1. Locatlon of land on which prop. osed work will be done MapNo .~;Z".:..'T.. ' ' m "' '~,~ Street and Number ~..~~ ~ ............................................................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .............................................. Intended use an Llnancv d occ_~_.._. ....... ~. .......... ~, .-~.......~, ......................................................................... 3. Nature of work (check which apl~licable): New Building ....................... Addition ..................... Alteration.../.. ......... Repa~f'~.....~ .................. Removal ......................... Demolition ........................ Other Wo r klm.. ~'f~f.... ~.~. _A~-~ .: ... e .~.~. ,~'Descri ption ) 4. fistimated Cost .... ~ Fe .... ~ .............................................................................. (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 ................................... 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 ..../.~....T...~... ....... Depth ....Z.~..~.. ................ Height ...................................... ;>,.~¥... Number of S.l~fies .................................................... 9. Size of lot: Front ~.~. Rear..~..~/.'.,/..v ............. Depth ...... ~..~...;,.w._. ........................... of Purchase~ .C...~'..... !.... Name of Former Owner .~.~"~?~.~..~.......~.:' ....~'.~:;7.~.a~..'~ .. ,. 10. Date 1 1. Zone or use district in which premises are situated ........ ~.~ ....................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........ x(,?..~.. .......................................... 13. Will lot be regraded ............................... Will excess fill be removed from premises: [ ] Yes ~r'No 14. Name of Owner of premises ..~.~..~-..v~.~.~.~-......~.~'-:....~:'.~;..~.~..~.,~.~,..., ............ ~.~..~....-..4~;~...~;;i,, ,,-,,~ ,, 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 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 YORK, ) SS COUNTY OF ......'~..~_~.~..~.~,~, ..................... ) ...... '.~-.~'~.......~--..~,~Y~.<,~.~...~.~- ........................... beinn duly ~vorn, deposes and says that he is the applicant above named. (Name of individual signing contract) ~ He is the ~ .......... ~,~ ~..~ ............................................................ ~ ....................................................................................................... (Contractor, agent, corporate officer, etc.} of said owner or owners, and"Ils 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 therewlth. Y PUBL C S .......... .................... day of ........... ............... " ' no. 52-6188295 ~N · C~> ~(ualified in Suffolk County No,ary Pub, lc, ....~.....~~en...E. xl~,rt~ch 30, ,S..c/~ ................................................................................................... ~ {Signature of applicant}