The URL can be used to link to this page

Home My WebLink About6747-z FOI~M NO. ~ TOWN OF SOUTHOLD BUILDinG DEPARTMEbtl TOWN CLERK'S OFFICE SOUTHOLD, N. Y. (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°. 6747 Z Date ............ ~ ....... :.... J.u~. ....... 25 ......... , 19.?.2~.. Permission is hereby granted to: Floz'enoe LaFrinere to ..F~m.e,e.t..z,n~...main~ir,..a...gr. ound...$1gn* ~ ' ................... "~ ......................................................... at premises located at ...... .................................... ............. .~.~.~¢...,.~.~.,x.,.. ............... i ........... :....' ......................................... pursuant to application dated ' I9 ......... and approved by the Building Inspector. [" Building Inspector FOI~M NO. 1 TOWN OF SOUTHOLD ~ BUILDING DEPARTMENTi TOWN CLERK'S OFFICE ................................................ ........... Application No...../~....2.~./...~ .......... Date .................................. 19 ............ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ifik and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according tb schedule. b. Plot plan showing location of lot and of buildings on premises, relatio~nship to adjoining premises or public streets or areas, and giving a detailed description of layout ofproperty must be drawn gn the diagram which is part of this application. c. The work covered by this application may not be commenced befor4 issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue c) 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 Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department far the msuance 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 fpr removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, buildibg code, housing code, and regulations, and to admit authorized inspectors on premises and in. buildings for necessary in§pections. (Signature of applicant, or name, if a corporation) ...................... ...... .............. (];] ............................................. : (Address of epplicant) State whether applicant is o~er,...~..~.~...R.~..lessee, agent, architect,~ engi,neer, general contractor, electrician, plumber or builder. ............................................. ............. .............. ; .......................................................................... Name of owner of p em.se:~ ......... ..~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 propos~/l work will be cJo9~. /~gp No;://..~ .............. .,~ ................ ~, Lot i~lo ......................... Street and Number. ~..: ~'~¢.:..~. ?.'.~.. ~. ~ ~.....~./..~?..~/.. .................. : Municipality State existing use and occupancy of p/r~mise~s and intended use andi occupancy of proposed construction: 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, Jf 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 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 ( ) N 14. Name of Owner of premises .................................................... Address ................................ Phone No .......... t .......... 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-bock dimensi ,ns from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. .. STATE OF NEW__YORK, I S S ' (Name of individual signing contracf),. above named. He is the ............................................................................................................................................................................ (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 and file this application; that all statements contained in this application are true to the best of his knowledge and be!ief; and that the work will be performed in the manner set forth in the application filed therewith. -, ,,~ ~ignoture or o/IRpljcant}