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Home My WebLink About6733-z FOItM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~ SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNT L FULL COMPLETION OF THE WORK AUTHORIZED) No. 6733 Z Permission is hereby granted to: ~ ............. X.a.tt~t~ck .......................... i .................. to~.1:c~,~:~ ~ ma~n:~xn.....6£.L~'l:~ek&d~...~o~o~- ................................................................. at premises located at.....,~D.t~..~ .............. ~[l~,~..~Ct~e,~ .......................................................... , .................................. ~a~dln~..Lan. .............. ~r~e~o~.~ .':..~.~.* ......................... ~ .................... pursuant to application dated ......... ~..~-.~.~.*.. .!~ , ]9..~..3.., and approved by the Building Inspector. Fee $~..OQ ............ J/ SOUTHOLD, N. Y. Examined 192.,~. Approved Disapproved a/c ......................................................................................... FOII,~'~ TOWN OF SOUTHOLD BUILDING DEPARTMEN TOWN CLERK'S OFFICE Application No....~..'~....~ ............ APPLICATION FOR BUILDING FERMIT INSTRUCTIONS ~ o. This application must be completely filled in by typewriter o~ in ink and submitted n trip icote to the Building' Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according fo schedule. b. Plot plan showing location of lot and of buildings on premises relati~)nship to adjoining prem ses or public streets o~ areas, and giving a detailed description of layout ofproperty must be drawn bn the diagram which is part of this applicotion.~, c. The work covered by this application may not be commenced befor~ issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue b Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in pa rt for any purpose whatever until a Certificate of Occuponcyg~ 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, NewlYork, 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, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (S gnatu~e of app icant, or name, if a corporation) .................................... (Address of opplicanf~ State whether applicant is owner, lessee, agent, architect, engineer, geneKal contractor, electrician, p umber or builder Nome of owner of premises .... '~ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder s License No ..................................................... P ' ' L'e ' umber s lC rise I~JO ................................................. Electrician's License io ...................................... Otiici°!:!i~fsi!!i!i~'~ i,~.~ ~)"~:'~:: Map No ............ Municipality 2. State existing use and occupancy of premises an~ intended use ~n~ occupancy of proposed construction: b ntended use and occupancy 11. 12. 13. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .............. Repair .................. Removal .................. Demolition .................... Other Work ....~.~ Estimated Cost .............. ..~..~. ~.. 4...~...~. ....................... Fee .................................... /~'..~.~.. ~.. .................................. (to be paid on filing 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 occupancy, specify nature and extent of each type of use ........................... 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 ................................ Dimensions of entire new construction: Front .................................... Rear ............................ Depth ...................... Height .................... Number of Stories .................................................................................................................. Size of lot: Front ........../.~..~.. .................................... Rear ............. /..,~..~. .................... Depth ...../..~.~...'~.. .............. Date of Purchase ........................................................ Name of Former Owner ...... .~.....~...(~....~....!..~.....~....~. Zone or use district in which premises are situated .................................................................................................... Does proposed construction violate any zoning law, ordinance or regulation: ........... ..~'~...4~.. ................................. Will lot be regraded ............................. Will excess fi, Il,be removed fro~ prer~ises: ~ ) Yes. ( ) No Name of Owner of premises ..~N,~......~..~..... Address ~...~.;.... Phone No. E .~'.S~',~' 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 dimensic property lines. Give street and block number or description according to deed, and show street names and whether interior or corner]~_ ~ duly sworn, deposes and says that he is the STATE OF NEW.~OJ~,.// ~c c COUNTY OF .......... . .'~-.~....~ .~. '..~..t ;~g3~ .~.. ....................................... being (Name of individual signing contracf) above named. He is the ........... .C,.~..~.~..~.~,.A~t~. ................................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make o~ this application; that all statements contained in this application are true to the best of his knowledge end beli~ that the work will be performed in the manner set forth in the application filed therewith. Sworn to before m~ this ~~ ~ ~~ ........ '~.'~ day of ...~.'~1 ....... ............................ 19.~ ~~. Co,nty .................... TERRI LEE ELAK NOTARY pUBLIC, State ot Rew is from ndicote aF )lican~ file and