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Home My WebLink About6415-zTOWN OF SOUTHOLD 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? 6415 Z Permission is hereby granted to: "i~u i N I=0'i~ ~( FE IVC E GO .......... ..%..../..<....%~ ....... ~.,.~!.~ ................ at premises located at ~:~ ~/C''~ /~A Y ~//L-- ~ ~) ~/% pursuant to application dated ................................. ~.Z...f~Y]~.~ 19.Z~., and approved by the Building Inspector. Fee $...~ ............. Building inspector FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. Approved ............ Z..~.'.....m/~...~, 19Z..~:~'mi, ~.....~.~..'~.Z......~ Disapproved a/c ,..~._..._..__._.,. ..................................... ................................................................. ......... ....... ....... ............................. (Buildin~ Inspoctor) APPLICATION FOR BUILDING PERMIT ote ........................ , INSTRUCTIONS a. This application must be completely filled In bv typewriter or in ink and ~ubm~tted in triplicate to the Building Inspector, w~th~. 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Pict plan showing location of lot and of buddings on premises, relationship to adjoining premJ.ses~ or pubhc streets or areas, giving a detailed description of layout of property must be drawn on diagram which is part of thi¢ application. c. The work covered by this apphcation may not be commenced before issuance 6f Building P~rr~'it. d. Upon approval of this application, the Budding Inspector will issue a 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 part for any purpose whatever untda Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION iS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zonb Ordinance of the Town of Southold, Suffolk County, New York, and other applicab e Laws, Ord nonces or Regulations, for the construction ct buildings, additions or alterations, or for removal or demolition, as herein 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 inspections. (Signature of applicant, or name, If a corporation) ~ound ~ve, Mattituck,~'.Y. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........... ~t .......................................................................................................................................................................... Name of owner of premises ...~;~.,~-~,.:~¢.~:l..~,,...~.~..;~,..l~,~.~..t,.,...~c,~kf~. .................................................................. ~.. If applicant is a corporate, signature of duly authorized officer, (Name and title of corporate officer) r' all'ed one Ma No / I ~'~._~ Lot No ~'/~/;~ 1. Location of land on which propose~ ,w,o..u%w' D . · P -: ........ ' ......................................................... ~.¢ ~'----' / Municipality 2. State existing use and occupancy of premises and intended use and occupancy of p~'oposed construction: a. Existing use and occupancy .................. ~~..~_¥.¢ ...)._................ ................................................................................. b. Intended use and occupancy .................. ~;: ........ ~.¢~.,."...~'.~..' ............................................ 3. Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration .............. ? Repair ......................... Removal Demolition Other Work ............................. ................................................. F~ll~l~/~l~escr ipt ion ) 4. Estimated Cost ........ ~&'OO ........................ Fee ...~.~OO ...., ....... :........;..,:....:; ........ , .......... ; ................................. to De para on rmng m~s app~catmn~ 5. If dwelling, number of dwelling units ................. Number of dwelling units on each floor ......................................... If garage, number of cars ................................................. ~'",v'"'~ .............................................................................. 6. ~!f business, commercial or mixed occupancy, specify nature and extent of each type of use ..................................... (,~.~ 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 ......................................................................................... (~. ~,,, Size ot lot: Front ..... ~ ............................ Rear .~. .................................... Depth '"'~.~,~"'"~.0 ........................ Height .................................................... Number of Stories ...................................................................................... 10. Date of Purchase ..................................... Name of Former Owner ............................................................................ 1 1. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ............................................................ 13. Wig lot be regraded ..................................... Will excess fill be removed from premises: [ ] Yes [ ] No :~L4_:Name of Owner of premises '"'~,;~J.':~,'~'~"f',"~],~,'"t~.~ ...... i~'~'""'~'~'~'~'"'"'~'~'~'~;'~'~l.~ ....... 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. ~ C OUNTY,~%~ .......................... ~¢~,_~., ~ .............. ....... ......... ,¢i.~,i~.¢l~i~;~.j~.,. "'~' '' '~'"'"'~/ being ~nd says that he is the applicant above .amed. He is the &~e"$ .................................................................................................................. ~'~ ........................ [dbatr~ctor, ¢~e~t, corporate o~ficer, etc.) of said owner or owners, and is duly authorized to perform or hav~ .~erformed the said work and to make and file this application; that all statements contained m th~s apphcatmn are true to the ~t(~f[h~'~nwledgff~and behef; and that the work will be performed in the manne~ set forth ~n the apphcat~on filed therewith. ~ ,..r.' t'¢"b" "" ' ' ~ ' ,,,, ,,~ ~ ,,, ~, ~~ ~Z~. ................. '9 ............... dayof. / ......'~. :; ........ e,..,,.,..,'.':.'..',..~'19 '' ....... ~/~./.~ Notary PubLic, ~ .............................;~,.,.< .............................. County ...... ~ ......................... ....... TSignature ~licant)