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Home My WebLink About6695-z FOI~M N~. ~ 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) 6695 Z Permission is hereby granted to: et premises located ~t ................................. i,~'&'~ .......................... ! .......... ' ............................................... ........................................ ~...~..:¢.!m..~ ........... .~,~:~ ................................................. Buiiding Inspector. - Fee $1 ~',00 . FOI~M NO. 1 TOWN OF SOUTHOI~D ~ BUILDING DEPARTMENT TOWN CLERK'S OFFICEi SOUTHOLD, N. Y. Application No..~....~.~..~ ................. ,, ,, // Approved (~.. .................................... , ....... Permit No ............. ..-rr.i..... ..... APPLICATION FOR BUILDING ~ERMIT ................................................. , ~..~.~..~ ~Ns~uc~oNs o. This *pplic~tion must be completely fillod in by Iypowritor o~ in 'ink ond submittod in triplicoto to tho Buildin Inspector, with 3 sots of pl~ns, occurote plot plan to scal.e. Fee ~ccord rig. to schedulo. b. PIo~ plon showin~ locot~on of lot ond of buildings on premises~ relationship to ad~oinin~ premises or public stroets o~ oreos, ~nd Oivin~ a detailed doscription of I~out ofpropor~g must be drown on the dioorom which is port of this opplicotion.~ c. The work covered by this opplic~tion moy not bo commenced before issuance ~f Buildin~ ~ermit. Upon opprov~l of this opplication, the Buildino Inspector will issue:o 8uildin~ ~ermit to the opplic~nt. Such permi[ d. beNokeptbuildingon the premiSeSoccupiedavailableor for inspectiOnorthroughoutr thepar~f,o any work.purpose a shalle, shall be used in whole in t whatever until Certificate of Occupancy' shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for th~ issuance 0f a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk .County, Ne~ York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or o,terations, 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 n~essary ibspections. ...... Z~ ........ ~m~..~.....,~::~ .................... (Signat~r~cant, or namer if a corporation) ..... ............................. (Address o{ ~ppl~cfint) State whether applicant is owner, lessee, agent, architect,' engineer, general contractor, electrician, plumber or builder. ::::::::::::::::::::::::::::::::::::::::::::: .~. ~g n.~ :f~,~:ed of f icer. Builder's License No ..................................................... Plumber s License No ................................................. El~tri¢i~ s Ei~e~s~ Other Trade ~ Ei~s~ ]. ..~ ........... ~ot No ......................... ~.~e~ ~nd ~m~e~ .... ~.ZX.~.~: ........ .~....~.~...~~~~ ...................................... Municipality a. ...... ........................................................................ b. Inrenoeo uso OhO occuponcg .................................... J .............. ' ............................... ~J ............................................. ,, '3. Nature of work (check which opplicable):.New Buitdin~ .................. Addition ........... ~.., AlteraJjon ............... ; Repair .................. Removal .................. DemolitiOn .................... Other Work ~ ~'C ~ "~"~' (Description) 4. Estimated Cost ~.~. ................................ Fee ! C (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 c~rs ....................................................................................................................... 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 / O(~ ...................................... 7'~)"~ ...................................... '"~'~(~" (-~ ............. 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ....L.~.~../.L.'~.L.~...~. ................................. 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 exi?ting or proposed, and indicate oil set-back dimensions from property lines. Give street and black number or description according to deed, and show street names and indicate whether interior or corner lot. .............................................. ~ ........... ~'"'"~..z~ ...................... being duly sworn, deposes and says that he is the applicam (Name of individual signing con'cf) ' above named. Il He is ...................~ .......................................................................................................................... : ............................... (Contractor, agent, corporate officer, etc.) of s~id owner or owners, and is du~y authorized to perform or have performed the said work a.nd fo make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and tha~ the work will be performed in the manner set forth in the application filed therewith. Sworn to~efore me this ~ ~ / ~ ~ __ ~UDITH T Be)KEN (Signature of app~