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Home My WebLink About6683-z FOI~M NO. ~ TOWN OF $OUTHOLD 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) Ne 6683 Z Permission is hereby granted to: · Y~l:l:.a..,~..~o~ ....... ?~ekL~ .................. ........ ~e3.m~....~ ............................................... ~o .~Aq..z..o. ~..e...~.~..o. ~.e..~.~Z..~&.~.~..~.~...~ ....~d~.1~..f~,m ....................................... at premises located at ....... .~...~ ....... ~lL..~o'l~t~'..]~t~l~tt, ......................................... pursuant to application dated ........................... ~.....~;~..! ...... 19.~.., and approved by the Building Inspector. Fee $..!..,~...0~... .......... / ~' ?"''Bud(~ing 17~speCtor { Examined .. ~Z.....~......'.'~......, Approved ..~../. ................................. , ........................ -- (Bu'ii~l'iA'~ Inspectq~ ............................ TOWN OF SOUTHOLD BUILDINGTOWN CLERK'S DEPARTMENT OFFICE $OUTHOLD, N. Y. 19 TM Application No. 19 ........ Pemit No .................................... APPLICATION FOR BUILDING PERMIT q / Date ....... ..~ .~T:,~'~ ........................ , 19 // INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, wit~ 3 sets of plans, accurate plot plan to scale. Fee according to schedule· b. Pict plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, an,~ 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 or~'~ 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 Cet~tificate of Occupancy shall have be~n 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 Ordir~ance' o'[ the Town of Southold, Suffolk County, New York, and other applicable'Laws, Ordinances or Regulat,ions, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to eor~ply with all applicable Paws. 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 applicant) State whether applicant is owner, lessee, agent, architect engineer, general contractor, electrician, plumber or builder. amc of owner of em~ses .......... ~.'..., ...i~..,.,, ..... ~ ,~. Z ,,.~ z. ZZz~ , ............................................ If applicant is a corporate, signature of duly authorized officer. ..................... ..................... Builder's License No .......................................................... Plumber's License No ......................................................... Electrician's License No ..................................................... t ' O her Trade s Mcense No ................................................... 1. Location of land on wh ch proposed work w be done Map No .~...~.:...~ .................. Lot No...~.~ .............. Street and Number Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................................ b. Intended use and occupancy ~:t ~ ~'~ ~ Z~; ~' ¢ :~ ~.~ ........ ~-'~" ~'. .................. 3. , Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration.....;....'..'.., Repair .................... ; .... Removal ......................... Demolition ........................ Other Work (to be paid on filing this application) 5. If dwelling, number of dwelling units .................Number of dwelling units on each floor ......................................... If 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 ......................... Rear ............................ Depth ................................. Height ................................................. Number of Stories :...~ .................................................................................... 10. Date of Purchase ..................................... Name of Former Owner ../~. .................~:..~:~2... .................. 11. 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 ';'~O z-> '-'""' ~'"~' .............. Will exce~s fi!l be removed from premises: [ ] Yes (Address) Name of Architect ..................................................................................................................................................... . (Address) (Phone Jqo.) ~' {Address) /t'P h o n e~!i? · 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 YOR.~, _ ) COUNTY OF ......... . ~..~..~...~..~..~.., .~. ................ ) SS · ,.J'....................,.,.......,..~-~l being duly sworn, deposes and says that he is the applicant above named, (Name of individud si~ing contract) He is the ...... ~..~. ....... .~ ........................................................................................................................................................... (Comr~ctor, ~e~t, corpor~t~ officer, ~~ and is duly authorized to ~rform or have performed the said work and to make and file this application; that all statements contained m 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 flied therewith. ............. ................... ............ . , Notary Public, ._..~..[~&~O~[.,.SCJJ~.~ ................ Coufity .~ ........... ~..~{ ........ _ ................................. Term ExCites March 30, 19~ (Jig~at~te of applicant)