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Home My WebLink About6682-z FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERIC'S OFFICE SOUTHOLD, lq,. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6682 Z Permission is hereby granted to: · ~"~¢t'~"&~e .......... ........... }~..&..~lak, ha~ ................................... .................. Y~t.t,t;:L~t~k ..................... : .................. at p~emises located at .}(~..~;~L...~?.t.~.~..~¥e .................................................................... ............................................ ~ .~.t,:L~:Uek ....... ].*~* ................... '. .......................................................... pursuant to application dated .........................~a.~..-..~ ...... ......., 19-,'/.~..V, and approved by the Building Inspector. Fee $']:. ~.,.0~). ............ Budding ~nspector / BUILDING DEPARTMENT TOWN CLERK'S oFFIcE Examined ............. ~.~7.~...M 7~.. ............ , 19~..~... Approved ...... .~...(.., 1 .~.. Pemit N, ,,. ~: ~ ,~x Disapproved a/c ............................................................................................ ..... ~(B uffding InspectorJ ~ APPLICATION FOR BUILDING PERMIT ....... ....... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, wi~.F~ 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, a~d 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 issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept the premises available for inspection tl~roughout 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 be~ 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. ISignature of ~pplicant, 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 ses, ~.4(~.,(~.~-.Zh(.. ...... If applicant is a corporate, signature of duly authorized officer. ..................... i h . .d i,. . i i i .d . F ij 4. . 4.f i ; i ..................... Builder's License No .......................................................... P umber 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 ......................... Street and Number ..4.~.EE2..~.....~Z~.Z~...d~<r~~'. ............. ~.~:~ ................... Municipality 2. State existing use and occupancy of prem scs and n~nded use and o~cupancy of proposed construction a Exstn use and~cu anc .............................................. ~ ~ ZL/~g p y · e dad use and occupancy .................................................................................. ,: ................................... I~ature of work (check which applicable): New Building ....................... Addition ..................... Alteration ......... Repair ......................... Removal ......................... Demolition ........................ Other Work ..~.¢~.....~..~... .......... ~ _ ~ ~' (Description) 4. Estimated Cost ....... ~ .~./.': Fee Z~,,,,,.~ .......................................................................... (to be paid on filing this application) 5. If dweIHng, number of dwelling units ................. Number of dwelling units on each floor ......................................... L[ garage, number of cars ............................................................................................................................................ 6. If business, commercial or mixed occuoa~cy, specify nature and extent of each type of use ..................................... 7. Dimensions of existing structures, if any: Front .....................Rear ........................... Depth ................................... Fleight .................................... ~ ...................... 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 Stor.~s ....................................................................................... 9. Size of lot: Front ...~.y....~M.. .................. ...... yfi.,~......~. .................... Depth ....... ....................... 10. Date of Purchase ....'.~.~./.,Z...~.. ...........Name of Former g~wner ..... :~,t~..~.~T.i~..~-.,~Z~;E;~ ................. 11. Zone or use district in which remises are situated 12. Does proposed construction, v}iolate any zoning law, ordinance or regulation: ...... ~'....~....: ........................................ 13. Will lot be regraded ..... ~...~... .................. Willxex~cess fill be removed from premises: [ ] Yes [X~*No 14. Name of Owner of prem,ses ...~..4~2.~./..2~....~...~~ ........ ..~.~...,~..~...~....~.02.0~. ............. .?.~.~..~.'...~..~..~.~. . , (AddresS} (Phone No ) Name of Architect ..................................................................................................................................................... .~,~, ~ ~ ..~ (Address) _. (Phone No.) Name of Contractor .....___~.. .... 7' ........................................................................................................................ (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, CE s, ......... i ............... Ii ss .......................................................................................................... being duly swnrn, deposes a~d says tl~at he is the applicant above named, {Name of individual signing contract) He is the ....................... ~..%~;X.~..~ .................................................................................................................. : ............................. {Contractor, agent, corporate officer, etc. j of said owner or owners, and is duly authorized to perform or have performed the said work ~nd to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and ~hat the work will be performed in the manner 1he application filed therewith, '~£~ .............................. Notary Public, ..~.,':m,....~..~ ...... County .,.~...~.....~~,.~.: .................................................... / (Signature of applicant)