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Home My WebLink About6700-z FOBM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 6700 Z Permission is hereby granted to: ....... ..~...o.~.~...~...~ze.~. ]~/1~. .................... Orle:,~ .................................................... m .................... ~ ......... '. ........ ~,...~...~l~ty...[a~=~sn~.~l..~t~.~t t~m~ ................. at premises located at ...J/d~,..:J~ ....... ~,'i'e~t..l~,..4~he..ii~m.....I. ................................................ ..................................... ~ea..l~ta~..Lau~ .............. O~$e~....l~,lf..'. ....................................... pursuant to opD{icot{on doted .........................~[.Ulle.....~,~ ........... , 1{{~.~...., ond opproved by the Building Inspector. Fee $..~,~,,.~. .......... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE Date .............................................. $OUTHOLD, N. Y. Approved ..... i.. , 102..~.. Permit No. (.Z.~.....~....~ ....... ~Y ~ ..~ ~',0, DLsopproved a/c .... ~......~_.~ ....... ~.....~ ~/~ Zjlp(j, INSTRUCTIONS '~ a. This application must be completely filled in by typewriter of, in ink and submitted in triplicate to the Buildi Inspector, with 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 of ~, 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 will issue a Building Permit to the applicant. Such perm t~'~i shall be kept on 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 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 removg! 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 i' i'~nspe/c~°ns' /~, o[---' ......... ;';;;';F ...... (Address of aPplicant) u ............ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electriC:ion, plumber or builder. Name of owner of premises ....... ~.~......~...~..~..~....~..'~.....~...'~...~.... ................................................................ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's Liconse No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... Location of and on wh ch proposed work will be done Map No' ..'~...:,/~'~..~.~.,'1~¢~..... Lot Nn Street and Number ...'~'."."."."."~...~~..~.~ ........... (,~ .~..Z,...~....L~....I...~....~...~.,~.~.~...,~.~ ............. Munlcipality State existing use and occupancy of premises end intended use and occupancy of proposed construction: a. use 7.. Exisiting and occupancy .............................. .~,.. ........................................................................... ~ ........ b. Intended use and occupancy ................................................................................................................................ 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration - Repair .................. Removal .................. Demolition .................... Other Work .................................................... 4. Estimated Cost ...... ~ ........................................... .~....Fee .......................................................................................... (to be paid on filing this appllcation) 5. If dwelling, number of dwelling units ............................ Number of dwelling units'on each fl<mr; ............................ 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 Storie~ ................................................................................ '. ........................... Dimensions of same structure with alterations or additic~ns Front ....................................Rear ........................... Depth ................................ Height ................... :! ....... Number of Stories ................................ 8. Dimensions of entire new construction: Front ....~....."...~... ................... Rear ...~..~ ............ Depth ..~..../.Z ......... Dote,of 1 1. Zone or use district in w~ch premises are situated ................................................................................... : ................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ..~.~. .............................................. 13, Will- lot be regraded~ ...... ~ ............... Wil excess fill be removed from prerhis~s: ( ) Yes ( ) No Name of Architect ~ Address Phone No. Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM -; Locate dearly and distinct y a buildings, whether exi~tina or nronose([ and indicate all Set;ax~k, dimensions f~em~ .~,[ property lines. Give street and black number or description~accor~din~g to'deed, and show street names end ind'L.~'~i.,~ whether interior or corner lot. STATE OF NEW,.YOI~.~. ,'~. I c c ~ / ~-~-' COUN~_.~O? .~,CL.~..S~.L~..:...I",~ . ~,, ~ ~ ...............................:'1"~ ~ividu~:" igni~ ~ .............................. .being ~ swor~, d~nd .... says t~t he is the applicant ~ab°ve name.. ~ ~ ~e ~ ~ He is the (Con~?~tor, agent~ corporate officer, etc.) of Said owner or owners, and is duly authorized to perform or hove performed the said work ~d to ~ke and file this a~lication; that all state~nts contained in this application are true to the best of his ~owledge and belief; and thaz the work will be performed in the manner set fodh in the applicatio~ filed therewith. Swam to ~fom me this ...... ......... .... ..............- Na.. ...................... ......................... ~ M. ~ (Signatur~f applica~ Nm~l~ ~ ~ N~Y~ No. ~