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Home My WebLink About6696-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N: Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) 6696 Z Date ............. ............. '~'~t~ .......... 2~'"'"' 19..73- Permission is hereby granted to: ...... ~¢~ t ,t.i ~ ~ c ~ ................................. : ................. to ....... ',~:~.~:.~.~,.. ,~%] zd...~'~ fL;).~; ~.2v, ..a....2c,~,'...£,,~%~%. · ~]i~h.-.~ e.. en~.~o~ ...~...s ~e.. ~ et premises located at ...~.~-.~..~.~:'~ ...................................... , ......................................................... pursuant to application dated ....................... ~L~ .......... ~ ........ , 19..~/., and approved by the Building Inspector. Fee $~t ~., ~..Q ............ Examined .... Approved ...J FORM NO. 1 TO~VN OF SOUTI'IOLD ~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 19...~.~.. Permit No. ~....~.....?..~...~ ......... Disapproved a/c ............................................................... APPLICATION FOR BUII~DING/ PERMIT , ~ Date .........~../....~...~. 19...~,~.... INSTRUCTIONS a. This application must be completely filled in by typewriter or~ in i~k and submitted n trp icate to the Building~ Inspector, with 3 set~ of plans, accurate plot plan to scale. Fee according t6 s, chedule. '~. b. Plot plan showing location of lot and of buildings on premises, relatiohsnip to adjoining premises or public streets or areas, and giving a detailed description of layout ofproperty must be drawn on the 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 wiU issue c~ Bud ng Permit to the app cant Such permit shall be kept on the premises avoilable for inspection throughout the work~ e. No building shall be occupied or used in whole or in pa rt for any purpose whatever until o 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, buildir~g code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signatur~ of applicant, or name, if a corporation) ................... ' (Address b'f applicant~ State whether applicant is owner, lessee, agent, architect, engineer,~ general contractor, electrician, plumber or builder. Name of owner of premises '"'~'"'~'~' ~/ /i z~ ~ ........ D..~..~.~....~...[~.i..'...'...................................'..........~" "'""'"" '"'"'"'"' '"'"'"'"'"'"" '"'"'"' If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... Location of land on which propped work will be .done, Map No.: ....................... ~ ............. Lot No ............. Street and Number ............. ~~_~..... ...... ~-,-mrr.. ...........i.....~.-~.~..~...,~...c~~ ............ ' ........ State existing use and occupancy of premises and in~ended use and ~ccupancy of proposed construction: o. Exisiting use and occuponcy .....~'~.~.....~.~..~ ....~, .../. ................... ............ b. Intended use and occupancy : //~/~ ~ 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work .........: ..~,.~., ..~-~.. ~ .................... · ~ ,,_~ (Description) 4. Estimated Cost ...... ,.~,. ,.~-.,~., ........................................ Fee (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 ................................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ Nome of Former Owner ........................................................ 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 descriphon according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK -- JSS COUNTY OF .,--~.,..,...,~.(~e..J,.J~.....~' ' .... · ..~....~,~;,~?~, ..~,...~,.......,.....~....~...~.~v~5~l,~:~.:~ ........ being duly sworn, deposes and says that he is the appHcam u'~ame aT ma~waua~ s~gnmg ,eor~racTJ above named. He is the '~:~ ~ ~lq'"' '" '('~'~'~'r~'~'"~'"~'"~)'~ ~)'~'~"~'¥ ................................................ kJ - , g , p ricer, etc.) ............................. of said owner or owners, and is duly authorized to perform or have performed the said work and to make and this application; that oll statements contained in 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 filed therewith. Sworn to before me,this ~;~' // / ....... of ...,,d ................ , , ~/ JU~,lTI. ~. ~o~ ,, ' (~'"'~' '~ - "~('Sqgndfurer°f a~'pl~ Notary Pubhc, Slate o{ New Y~rk Ne, 52-0344963 Suffolk Commission Expires March 30,