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Home My WebLink About6451-z FOI~Ni NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. N? BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) ......... ..... 6~51Z Date ......... :~.: ....... , Permission is hereby granted to: /~ · fL::....-:.',. ...... ...N...u.:.~:.~.,.~......~......~.....L... ~/t~ ::~ at premises ~ocate~.at ........ w..~....~...~ .......... .r ............ ~)- ...................... '.r......~ .............................. .................... ~..~ ................................................................ pursuant to application dated ,-~ ~ , 19...~., and approved by the Building Inspector. Fee $ ........................ FOI~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN GLERK~'S OFFICE SOUTHOLD, No Y. Examined ..........· ...~. · ....~'~....;~: .......... 1 ~.~.....~... Approved ................. .(! ........ '.~ .......... , 19....?.. Pemit No ........ Disapproved a/c (Building Inspector) L Application No ....... .~....c;(. ?.~/. ........... APPLICATION FOR BUILDING PERMIT Date ~... ~..~,.~..~.......~.. ..... 19...~....~..,. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplJcete to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of Iot~and~of bud ngs on prem scs, relation~hi~to adjoinin,g, p?emi{es or public streets or areas, and giving a detailed description of layout of property must be drawn on d agram Wh ch is part of this apl~lication. c, The work covered bY this application may not be commenced before issuance o~[ Building Permit. d. Upon approval of th s, app ication, the Building inspector will issue a BuildinglPermit 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 wh'atever until a Certificate of Occupancy shall have been granted by the Building inspector. APPLiCATiON IS HEREBY MADE to the Building Department for the issu~nc~,q~f,a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffoik County, New York, and ot~er appli~abl~'Laws, Ordinahces or Regulations for the construction of buildings, additions' or alterations, or for removal or demelition, as fierein described. ?he applicant agrees to comply with all applicable laws, ordnances, bu Id ng 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) ...... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................. .................................... i ......................................................................... Name of owner of premises ......... ~ ................. .~J[~.~..'.~ .......................... ! ......................................................................... If applicant is a corporate, signature of duly authorized officer, i (Name and title of corporate officer) Builder's License No .......................................................... Plumber's License No ......................................................... Electrician's License No ..................................................... Other Trade's License No ................................................... {~, /~ 1. Location of land on which proposed work will be done, Map No ........... ,~' ........ /..¥~ .................... Lot No ......................... ~ Number ~]7~~~ r/-~ ~'--~ : .......... ~,~,~Dr.~l~mO.~.. Street and ~ ........ ~ .................................................... Municipality 2. State existing use and occupancy of pr~mises aQd intended use and occupancy of proposed construction: J) 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 ..~~ ............ ~ r (Description) 4. E st imate d Cost .../~{~,~..:.(,~......'." .............. ,Fee ................................................................................................. . (to be paid, on filing this application) 5. If dwelling, number of dwelling units .................Number of dwelling units on each floor ......................................... I'i~ garage, number of cars ............................................................................................................................................ 6. If business, commercial or mixed occuDancv, specify nature and extent of each type of use ............................. .~ 7. Dimensions of existing structures, if any: Front .....................Rear ........................... Depth ................................... Height ........................................................... Number of Stories ............................................................................. r)imensions 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 ......................................................................................... 9. Size of lot: Front ...................................... Rear .......................................... Depth .................................................. 10. [;)ate of Purchase ..................................... Name of Former Owner ............................................................................ 11; /Zone or use district in which pr, e, Fl~s are situated ............................................................................ 12;' Does proposedcor/stl~uct oi~ny zon ng law, ordinance or regulat on: ........ ..1~.../~.. ............................................ 13. Will lot be regraded ......... , ........................... _Will excess f[[I be.re, moved from premises: [ ] Yes -- [~/~ No__ 14. Name of Owner of premises ............ ~.,~[.,,,1~,.. ............... ~.~.,..~,..~.. ........... ~ ................,,~',,~.,,~, ...:~,~.1' .......... (Address) {Phone No.) Name of Architect ..................................................................................................................................................... Name of Contractor ........ ; ......................... : ............. , ................... (Address! (Phqne ~No PLOT DIAGRAM Lo'ate clearly and distinctly all buildings, whether existing or proposed, property lines. Give street and block number or description a~:cording to deed, and sh~ er interior or ~orner lot. name~ a Jimensions from indicate Wheth- STATE OF NEW._Y_ORK, ) COUNTY OF .......... .~x .~...~..~...,...~ ................... ) S~' .......................................................................................................... being duly~swor0,, deposes and says that he is the applicant above named. (Name o/' incli~ic~ual signing contract) -- , '.', ..... He is the .................................................................................................................................................................................................................. (Contractor, agent, corporate o[ficer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file t~is 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. T~l~t LEE ELAI( ~ ~ NOTARY ~JBLIC, State of New ¥o~1~,. ' Ho. 52-6168 ................................... of ........... , 30, co ,,v ...... ............... ................ Notary Public, (Signature