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Home My WebLink About6470-z FOEM NO. ~- TOWN OF $OUTSOLD BUILDING DEPARTMENT TOWN CLERK'S oFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6470 Z Permission is hereby granted to: .: ........ :;:.:...':....~h:.:::._..:.'. ........ '.....i...':...'.'....?. ......... ~. o at premises located at ...... L~f,..~..&..~.....C~a.~ep,..~:~t, IMi ......................................................... pursuant to application dated .......................... dkp. lt.'t.l....~) ........... 19~/..~..., end opproved by the Building Inspector. aliileetlen mutt be eomflktely filled in by 't~l~ewriter or in ink a~ submi~ed in tri~i~te to the ~iMi~ Ins~ o ~ ~ .~ ~ ~ ~mlm, rel~p to ~joini~ ~mi~ or ~blic st~ or m, ~ ~ ~ ~ ~ ~ ~ ~ ~ t~ of Buildi~ P~mit. Permit to the applicant S~ch ~er~j_ tdlall be kept on I=ar~.,for Ir~' purpme wtmtevar until a (~;tif~___ of (~ IfaMI h~ve been HEREBY MADE to the B~tlding D~umtrnent for the iuuance of I Building Permit pummnt to the Building Zone ~ ~, New york, ~l ~ ~iclble Laws, Ordina~eS or fleg~q~ f~r the,aol~tructt~ of m~tlem i~f~atteretiom, o~ for rermw~lition, as herein d~ctibed. The apldicant agrees to ~ with all alNaHclble i code, houltng codl, md ta~ulltiom, and to admit authorized inlpectors on 13remi~es and in buildin~ for neclstary inlRectiom. (Signature of aplflicant, or name, if a f:orlx)ration) (Addre~ of appti~Int) whether, al~licant ~s owner,' __h~__, agent, amhitKt; etlgiheer, ~leneral contractor, electrician, plumber or bulkier. Number of propomd comtruetion: Inl~dad u~e and oc~upmcy TOWN OF SOUTHOLD T CLER ' .~,,~u~.~ ~, ~ / ~//7 ............ ~¢ .............. ,......, .: ..... , , ~ . :, PP ................... ;~......./... ~pproved ................................. ..I....., ]9.%.~. Pemit No. ~ ................ ::'""k ......... Disapproved a/c ............................................................................................ ......................................................................... ~ ...... ~¢ '=: ....................... ................................. [~ullalng Inspector] APPLICATION FOR BUILDING FERMIT ....... ................ , INSTRUCTIONS a. This application must be completely filled in by tvpewriter or in ink and submitted in triplicate to the Building Inspector,~i~h~ 3 sets of plans, accurate plot plan to scale. Fee accordmg to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or pubhc streets or areas, a~ giving a detailed description of layout of property must be drawn on diagram whi6h is part of this application. c. The work covered by this application may not be commenced before issuance 6f Building Permit. d. Upon approvaJ of this application, the BuiJding inspector wii) issue a Building Permit to the applicant. Such permit shall be kept on the premises avadable for inspection throughout the work. e. No budding 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 issuance 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 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) (Address of applicantl State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plun~ber or builder. _ ~.¢z.c~.~t.'.~ ....................................................................................... J~ .L ',' .................... Nameof owner of premises .... .~L.~.~,*,....,~ ........ ~.k~.~..~..~'..~.¢~.~.).O...~(~...C~..~'~ ........................................... If ~t is a corporate, signat~pce of duly/authorized officer. ........................ / ...... ~'[~me and tft[e o~fCd'~:r'porate officer) / C~.c .w..¢.:~.. rs. ' Street and Number ..... ¢;.~ ......... I,/~. ....................................... Municipality '~1State existing use and occupancy of p~nded use and occuPancy of proposed construction: · Existing use and occupancy ...................... ~ ........... .~ .................. .................. ~ ............ , ........................................ ~ Intended use and occupancy ...................... :~. .................. ' - /~/ ' ///~...,~~~.....~5~ ............................ Nature of work (check which applicable): New Building ~ ..................... Addition ..................... Alteration .... Repair ......................... Removal ......................... Demolition ........................ Other Work ..,.,..~. ~.~, ~,~,, ......... .~ ' (Descr pt on 4. Estimated Cost ...... ~...'...::;..: ............................ Fee .........I. ...................................................................................... (to be paid on filing this application) ~. '. If dwelling, number of dwelling units ................. Number of dwelling units on each floor ......................................... If gd~'age, 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 ............................ Depth ................................. ................................................. Nqmqe$,grr~Stories-~"' .................................................... ; .................................... Height '~ "' ~ ~ ~' Rear ..... /~;;...'~ ......................... Depth ! ~ (''' 9. Size of lot: Front ...... ~¢.....~....i .................................................................... 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 f¢ill be rer~oved from premises: [ ] Yes [ ] No -..~ 14. Name of Owner of premises ..!~..~..t...J.,...( ........ .,~.~"..;....;:...;'.?..¢.,..d:..?_:'.....,'..~........~..?..4..(..! ............... ;~...,';/......;....~.:;.....;,;,.'¢ (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. ,I STATE OF NEW ~RK~ .. //~ ) ................... , - ' ' ' ~% ' ' ' ' being duly sworn, deposes and says that he is the applican~ He is the ../.¥./ .............. ~ ......................................................................................................................................................................................... ' (Contractor, ~e~t, ¢orpor~te offi~'er, 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 al~ statements contained in thru application are true to the best of ~)~No~l~nd belief; and that the work will be performed in the mann'e~ set f)rth n the~Dli~t on filed therew th. . .................... / ............... d~v of ........... ~/~:..~.~.¢ ........ ~ ................. // ./ (~ - ~ ; (Signature o] apptiba~U