The URL can be used to link to this page

Home My WebLink About6722-z FOEM NO. ~ ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~ SOUTH'OLD, N'.. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 6728 Z Dote ............ :....-~.~...L...~.. ....... J./. ........... , Permission is heKeby granted to: ...~ .............. ~ j,~o,~ ~ ............ ~, ~ ............. .~.~.~.~.~.~=~...&~.c.....¢.~.~... .. ~ .~.~..T...~...-:~..~... ........ ~../.i. ................. ~o FA,~ ~f~..~. ~.L...~..~.e~.~...:..: ............................................ o, ~,~ ,o~o,~ o, ...~~~...~....~...~ ....~. ~ ................ ........ ...................................... :..:: ....... pursuont to opplic(~tlon doted .................... ~ ........ , ., °nd opprove the L/ / Building Inspector. ....... 7'"" ......... [~,:;,'~;;,'~'~ ~n.~cto'"'"r"-"-""/ .................... TOWN OF SGUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~ $OUTHOLD, N. Y, ~proved ............... 1 . ....... Pemit (Bui aing ~.~,Specror~ Application No.....~..2...?...~ ......... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a, This application must be completely filled 'in by typewriter or in ink and sub~nitted in triplicate to the Building Inspector, with 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 tc~ adjoining premises or public streets or areas, and nga deta ed 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 B, ui[din§ Permit. d. Upon approval of this application, the Building Inspector will issue a Building Pelrmit to the applicant. SuCh permit ?all be kept on a premises oval!able 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 snted by the Building Inspectoh APPLICATION IS HEREBY MADE to the Building Department for the issuance o7 a Building Permit pursuant to the Building Zone 'dinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of ~ildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees ~o comply with all applicable laws, dinances, building code, housing code, and regulations, and to admit authorlzed /~,.~ ~,~,~/~_~...~_~ \ inspector~cm premises and i~i.j~gs for necessary inspections. '(Signature of applicant, or name, if a corporation) (Address of applicant) tte whether applicant is owner, lessee, agent, architect, engineer, general' contractor, electrician, plumber or builder. me of owner of premises ,~,~.~.../..L:..,.~,,~..~....~.,~..~,,....~...:.....~,.4~ .................................................................. ~pplicant 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 proposed work will be done. Map No ......... ,....: ............................... Lot No. ..,..... ....... ......... Street and i~umDer .................... ;; ............. ¢.~......~ .....................................~ ...... ;....-~ ....... -'.! ....................................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: /. a. Ex,st,ng use and occupancy ... -G~Z....~......-~:~:.....~..:.., ....... /~...,....:~.?~.. ....................... , ................................... b. Intended use and occupancy ....... ~-~.~.~....' ......... ~,~.~!..:.~........~...~.-...-.~ ....................... Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work' ..,,~...¢...~¢.. ~....e~......~-...T~..~.¥ (Description) /J ~.. Estimated Cost ....... .~....~......'2~. .................... Fee ...~....o~.....;~ ............................................................... (to be paid on firing this application) If dwelling, number of dwelling units ..... ~'.. ......... Number of dwelling units on each floor ......................................... If garage, number of cars ................. ./. ........................................... ; ............................................................................. If business, commercial or mixed occuDancy, specify nature and extent of each type of use ..................................... Dimensions of existing structures, if any: Front ..................... Rear ........................... Depth ................................... Height ........................................................... Number of Stories .......................................................................... i.. ' Dimensions of same structure with alterations or additions: Front .......................... Rear ........ ~ ................................ Depth ............................................. Height ........................... ; ............. Number of Storig~ .-~,.m.,.~ ............................ Dimensions of entire new construction: Front ......................... Rear ............................ Depth ................................. Height ................ ; .............. ; ................. Number of Stories ......................................................................................... Size of lot: Front .......... (...2;..../ ................... Rear ........ ~...~.-..Q .................. ;..:;;-. Depth ;...;../...,~......~..... ................. i ........ Date of Purchase ..... ?...~. ~..~..../...7...z~.. ........ Name of Former Owner ./t2'~.#..~.~.. ¢.~.¢,~......~..... ,~¢, ./_/..r~./'.~../.......... .:.....z~:.~-.:2'"¢ Zone or use district in which premises are situated ........................................ , ........ ~ ................................................... Does proposed construction violate any zoning Jaw, ordinance or regulation: ............................................................ 13. Will lot be regraded ..... ~;./.¢. ..................... Will exce~s fill be removed from premises: [ ] Yes ~_~ [, ] No ~ . f wnerof remises.~/~ .~..'4¢~-~'~~*' . r_¢/~.~ ./_/ ~/'//~.~.ZC',~/-?/..~<:A. =~'2 - 14. Name o O p ......................................... ~....~ ...... ,..~......,..~. ............. ~......&~, ................. ~...~....;~ (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 description according to deed, and sho~ street names and indicate wheth- er interior or corner lot. ·ATE OF NEW YORK~//,~2., ? ~/ ) ~ ~ ~(IFF~ ~UNTY OF .......... ~~ ................. ) ~ ~ "'/~' ~ ~ (¢~~--~ ~ being duly sworn, deposes and [Name oj' individual sipdng contractj .............. b~, ~2-003~85-$uffolk ~url~ says that he is the applicant above named. is the C~. ~ ' (Contractor, 4rgcnt, corporate officer, said owner or owners, and is duly authorized to ~rform or have performed the said wo~k and to make and file this application; that all tatements contained in fh~s application are true to the best of his know~edfle and belief; and chat the w~rk w~ performed ~n the manner forth m tho application flied therewith. /""7 ~ /' / e/ '