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Home My WebLink About6455-z FOI~I NO. ~ TOWN OF SOUTHOLD I~UILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (TH I~ ~T ~U~T ~ ~ EPT ~ THrE P~ ~ ~E~ ~T~ L FULL COMPLETION OF THE WORK AUTHORIZED) 6455 Z Date ................. ....... J~rtl ........1~ .......... , 19...~.3. Permission is hereby granted to: ............ ~e~n~*.~.ve ................ ~ ............................. ...................... Ymtt :[.tu~k ...................... i ............. ~o ..... e~e *~..a ~1.. ~a.~-n.~-a ~e-. ~.. s.~. de .. &.. ~ar ..y~rd..' £~nee ............................................... at premises located at ....~/..~J..]~:~l~g...J~.~ ...................................... ~ ..................................................... .................................................. ..o.~...x.~.~ ......... ..~!...~.:. ...................... ~ ..................................................... pursuant to application dated ........................... ]~.~tJl.....~.....:., 19...~'~, and approved by the Building Inspector. Fee $....I.~.~.00 ......... / v ~uildin~ ~nspec~t~r / Approved ................... '.!......~.! ........... , FOI~M NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Yo Application No ............ ..'~.. ......... Disapproved a/c ............................................................................................ (Building Inspect7 APPLICATION FOR BUILDING PERMIT Date ............. ~ ................ , ]9.. INSTRUCTIONS ~ a. This application must be completely filled in bv typewriter or in ink and ~ubmitted in triplicate to the Building Inspector, wi 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot end of buildings on premises, relationship to adioining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on diagrem whi~;h is pert of this applieetion. c. The work covered by this application may not be commenced before issuance df Building Permit. ~ d. Upon approval of this appltcation, the Building Inspector wdl issue ~ Buildm(j Permit to the applicant. Such permit she~ be kept 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 until a Certificate of Occupancy shall have beenI granted by the Building Inspector. APPLICA'I'ION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone! Ordinance of the Town of Southold, Suffoll~ County, New York, and other apphcable Laws, Ordinances or Regulations, for the construction o[ 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, ~f a corplration) (Address of applicant) State, is. owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If app2~c~Ci~s a,~/~orat~gn~,u,u~.,,~ly au~thorized officer. ~ ' / (Name?~(dtitleof6'orporateofficer) 1. Location of land on which propos, ed Nork will be done. Map~o.: ......... .~,~... Lot No ........~..,,~...~... ...................... Street and Number ..~-,~,.'. ...... ...~...~ ............ ; ....................................................................... ~F~ ~_ ,,::)) ~f Municipality 2. State existing use and occupancy of pre,~.~es and intended us~ ~d~ occ~u:~.n~ ,cy~/~pr~op~osed construction: a. Existing use and occupancy ......... ~._~,zf:l~,....~..z'//z~.~, ..,~.....: ........................................ b. Intended use and occupancy .............. (,...,( .................... ~....I/. ......... ./ ....... ,/.,...~...~. ............................................... Natare of work (check which applicable): New Building ....................... Addition ..................... ~Alterati°~ ..........'~ .... Repair ......................... Removal ......................... Demolition .............. ., ......... Other Work ~ ~i .......... 4. Estimated Cost ............... ./...~. ~ '~..~,,).. ~ Fee ~ ~.'"~ ~.. (to be paid on filing this application) # 5. If dwelling, number of d~velling,units ....... ./.. ....... Number of dwelling unit~ on each floor ......................................... ~f 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 ......... ..~.J .......... Rear ......~.~-~.!..~. ......... Depth .....I..~...[,./. ................ Height ................................................. Number of Stories ......................................................................................... 9. Size of lot: Front ...................................... Rear .......................................... Depth .................................................. 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. Will lot be regraded ..................................... Will excess fill be removed from premises: [ ] Yes [ ] No 14. Name of Owner of premises ....................................................................................................................................... (Address) (Phone No.) 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 Y.O, RK, t, ) COUNTY OF ...... ~..M... ~..~.. ~.~..~ ..................) SS ~'..~O..)l'¥~O*,:~.-..,J~..,...:..,~....(~...(~.~.(~..~.~..~.... .................... being duly sworn, deposes and says that he is the applicant above named. He is the .....~.~ ,~,~ ...................................................................................................................................................................................... D (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform orhave p~erformed the said work and to make and file this apolleation; that all Jl n r~er~lUDTII T B < . statements contained in this application are true to the b~t,n~ h~s,l(no~/lei~[~nd bel el; and that the work will be performed in the manner set forth in the application filed therewith. , No 52-0344963 Suffuik Co~ally~, / ............... ....... __ d~' ' - - (Signature ~ ~ri~plicant)