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Home My WebLink About6765-z FOlt~ NO. ~ TOWN OF SOU'I'HOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~. Y. B,UILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6765 Z Permission is hereby granted to: ~.. F. ox~k..F, enee...C~ ..~.C...~.,eh~ ..&..L~tlda Be:~tan:[ ............ 3~..~ .......... smma..&v....i ................. ................. ~.~.t.,,t.~.~.~...~.:.~ ... i ....... i ................. to ..... ltl~.~.mad..~tJ~t~t.n.....6£t,. ....... ~a~,..~r.~ .......................................................................... ;: ........ ................................................. at premises located at ............ C,O-~I.4~;L.~..~Da~ .................. :....i ......................................................... .................................................. ~out~o~t ....... 1~ ~., ................ ~ ......................................................... pursuant to applicatior~, doted ......................... ~,y. ....... ,~O....!,..., 19.~$,, and approved by the Building Inspector. Fee $.-..~,00 ........ Building Inspector FORM NO. 1 TOWN OF SOUTHOLD'~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. Application No ................................. Examined / ~ [ ,- Approved ........................................ , 19 ........ Permit No. : ..................... ~ ............. Disapproved a/c , ; .* ~ ...... x · . ,. ~-~ ................................ i '"",'(- ....................... APPLICATION FOR BUILDING ............... ................ .... INSTRUCTIONS a. This application must be completely filled in by typewriter or~ in ink and submitted in tripJicate to the Building 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, rebtjonship to adjoining premises or public streets o~ areas, and giving a detailed description of layout ofproperty must be drawnion the diagram which is part of this applicdJ;ion. c. The work covered by this application may not be commenced befoj~e issuance of Building Permit. ,b d. Upon approval of this application, the Building Inspector will issue'a Building Permit to the applicant. Such perfnit shall be kept on the premises available for inspection throughout the wo~k. e. No building shah be occupied or used in whole or in part for any pdrpose whatever unti~ a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for th~ 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 a~terctions, or Ilar 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 ir~spections. ant, or name, if a corporahon ......... .... ¢ ............ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....................... ........................................................... , ............................................................................ Name of owner of prem se~,:. ~ ~ .............. . .......................................... · ' · ................................ If appli,far~; is a,Corporay~,x~a~e o,~f~ duly authorized officer. ~D"~/~ ti~'~o~r~6o'Tp~rate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. : Other Zrade's License No ............................................... ?' ~ Location of land on which proposed work will be done. Mop No.: ... .................................... Lot No ................ ~. ....... Street and Number '~~(~'~':c~,~.~, ~ ............................ : ...................................... ;,'~'Y,~.~'~ .~.~'"~~,x~zr ~2~2-_ ,~_" '~ "~ ~v~un.c,pcd,[y State existing use and occupancy of premises and infended use an~l occupancy of proposed construction: O, Exisiting use and occupancy ......//~. ....... ,~....~.~.".~./,~, ............ ......... ,,.....Z,/....;>..~.... .......................................... b. Intended use and occupancy ...... } ........ ~ ........................ ~' .......... ! .................. ~. ................................................... 3. N t~(~ work (check which applicable): New Building .................. Addition ....... ~ation .............. ~epaJr .................. P, emo¥ol .................. Demolition .................... Other NVork ..... ~ ................ z'l ....................... ..".' -- (D:~scription) / 0 4. Estimated Cost 6~ .,~., &/ 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 ............ /...~'....O.. ................................. Rear ......... /(..,~.4] ....................... 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,, ......... .,,//,,,/,,,,,v~Will~,ces, s fill be removed f~o/preF~i~_s.'~ ) Yes ( 14. Name of Owner of pre~~.~/"" n'~ ~ '- ............ Address~~i-.:.Phone/'~f~'r~'~4 ~,~ No .......... r~ame or ~rcm~ect ........ : ............................. ~L ................... Address ................................ Phone, No ......... ................................. /.' ........................ Address ................................ Phone Na .......... Name of Contractor PLOT DIAGRAM Locate clearly and distinctly all buildings, whether exb, fing or proposed, and indicate all set-back dimensk property lines. Give street and block number or description according to deed, and show street names and wheth~,~r interior or corner lot. J ,ns from indicate STAT~ · (Name of ~ndividual signing contract) 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 :nd file this application; that all statements contained in this application ore true to the best of his knowledge and be ief; and tho~ the work will be performed in the manner set forth in the application filed therewith. Sw~efore me this~ ..................... ~day of Notary Pubhc, . ................................................... County ~...~~~ .......... ~/~~..~ ......... / (~gAature o~pl~cant) - TERRi LEt E~K NOTARY PUBLIC, State ol ,,~w }ork