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Home My WebLink About6771-z FOI~M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6771 Z Permission is hereby granted~: · "~'~'=~-~'=~:'1 ............................... .......... ~~.~ ~ : ............... .................. pursuant to application dated ...................... ~w~.~-~.....~.~.. ..... ,O~...L-'~.... and approved by the Building Inspector. Fee ...................... l~Olll~ NO. TOWN or SOUTHOLD BUILDING DEPARTMENT~ TOWN CLERK'S SOUTHOLD, N. Disapproved a/c ..... ............................... .............. ........................... ........................ (Building Inspe(~tor) /~ / APPLICATION FOR BUILDING P~RMIT iDa,e ........ a. lhi~ application must be completely filled in by typewriter or in ink and ~ubmitted in triplicate to the Building Inspector, wit~ 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 or areas~ an~ giwng a detailed description of layout o~ property must be drawn on diagram whigh is part of this application. c. Tha work covered by this application may not be commenced before issuance ~f Building Permit. d. Upon approval of this application, the Building Inspector will issue a Buildin0 ~ermit to the applicant. Such permit,shall be kept on the premi§es available for inspection throughout the work. , e. No building shall be occupied or used in whole or in part for any purpose wl~atever until a Ce(tificate of Occupancy shall have beer~ 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, SuffoJk County, New York, and other apphcable'Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described, iThe applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectS)rs on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) .......... ............. ........... (Address of applicant) State wheth,er applicant is owner, lessee agent, architect, engineer, general contractor electrician plumber or builder. ................. .................................................... , ......................................................................... Name of owner of premlse~ ...... .~.~.l.~-.~-u.~ ............................................................................. ' ............................... If applicant is a corporate, signature of duly authorized officer. l Name and title of corporate officer) Builder's License No .......................................................... Plumber's License No ......................................................... E ectr c an's L cense No ..................................................... Other Trade's License No ................................................... 1. Location of land on which proposed work will be done. Map No .......... i .................................... Lot ...... Municipality 2. State existing use and occupancy of. premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ........................................................... :~ ........................................................................ b. Intended use and occupancy ............... ~--.~,~,.~--~L'~.. .................. :~ ........................................................................ Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration.. Repair ......................... Removal ......................... Demolition ........................ Other Work ..,.~...,%~.....~., (Descripti( , ' .... E!stimated Cost .....,'El ................................... 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 occuoancv, specify nature and extent of each type of use ................................... Dimensions of existing structures, if any: Front .....................Rear ........................... Depth ....................... ..........., Height ................... ........................................ Number of Stories ........................ r ................................................... 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 ............................................... 10. Date of Purchase ..................................... Name of Former Owner ............................................................... 11. :Zone or use district in which tSremises are situated ....................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .............................................. 13. Will lot be regraded .................. t., .......... ~.. Will excess fillbe remo~ted from premises: [ ] Yes [ ] N (Address) (Phone No Name of Architect ........................................................................................................................................ (Address) (Phone, No~ (Address) (Phone No.) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimens property lines. Give street and block number or description, according to deed, arid show street n&mes and indic~ er interior or corner lot. ~ te wheth- .C 'O ATE 0E NEW~,~,~ ) ~F ............................................... ) SS ~, 4 ,, : - ............................... ..,..,!,. ................................................................... being duly sworn, deposes and says that he is the applicant al: ~ve named. .'~. ~.~¢nb of, individual si~ing contract) ' ' He is the _..;.;.~, . ........................ '-~'~ (Contractor, agent, corporate officer, etc. j of said owner or owners, and is duly authorized to.~rfoO~>g~a~{ormed the said work and to make and file this applica' statements conta.ned m th,s apphcatmn are true to ~'h~ ~O~Nd b~f, and that the work will be performed set forth in the application filed therewith. ~, ~-0~44~63 ............. ................. ,., o,, ......... ....... ~ _ ~ (Signature of applicant} ion; that all the manner