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Home My WebLink About6781-z FOltM, NO. ~ TOWN OF SOUTHOI. D BUILDING DEPARTMENT! TOWN CLERK'S OFFICE SOUTHOLD, N~ Yo N°. BUILDING PERMIT (THIS PERMIT MUST BE 'KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) 6781 Z Date ............. i ...... '..... ,,~...~. '~' · ',~- ~. ....... ,~.,....., 19.,~. Permission is hereby granted to: · ~.~.~..~. ...... :~ ..................... i ................ .............. .~..,...~.~.y.~.~.~.. ~..~L~.~ ~.~ ................. ~ er,e..et .n...e..w. sec~i.o.n~ of 6ft & ~ft fence rab~ild existing fences at premises located at J~ t .B~..~..~ew ~o~L & S~.~..i i~..~.~ ........ ~..~ ...................................... PUrsuant to application dated ............ ,~ . , .8 .i~ , 19.~.~i., and approved by the I~uilding Inspector. Fee $.J.~..t..O.~ .......... Building inspector / I ., FOENI NO. 1 %-,~., TOWN OF SOUTHOLD ' " BUILDING DEPARTMENT! TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ...... ......... ............. I (Buildin~ Inspoctor) ~ ~PPLI~TIO~ ~OR 8HI[~I~O ~RMIT Bate ....... ~ ......................... ~ 19. I~STRHCTIO~S a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according go schedule. b. Plot plan showing location of lot and of buildings on premises, relati6~nship to adjoining premises or public areas, and giving a detailed description of layout ofproperty musi be drawn On the diagram which is part of this applio c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue .9 Building Permit to the applicant. Such p~e~rmit shall be kept on the premises available for inspection throughout the world. ~ e. No building shall be occupied or used in whole or in pa rt for any purpose whatever until a Certificate of Occup~FR~y shall hove been granted by the Building Inspector. ~ ~ APPLICATION IS HEREBY MADE to the Building Department for the ;:issuance of a Building Permit pursuant/t~ the Buildin~ 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 ah'erations, or ior removal or demolition, as herein desc~bed. The applicant agrees to comply witB all applicable laws, ordinances, buildi]ng code, housing code, and regulations, a~d to admit authorized inspectors on premises and in buildings for necessary inspections. ~ State ~hether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................ :': ...... : ........................................................................ Name of owner of prem ses ~:::~ ~,f3 ~(5~ ~ 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 Zrade's License No ............................................... Location of land on which proposed work wilt be done. Map No.: .... ................................... Lot No ......................... Street and Number .......................................................................... [ ........................................................................ Municipality State existing use and occupancy of premises and intended use ancj occupancy of proposed construction: o. Exisiting use and occupancy ...................................................... i ........ ~/>~'~'~ ................................ b. Intended use and occupancy ...................................................... ~ ............................................................. ....~.l..~' . 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration ....... ¢ ........ Repair .................. Removal .................. Demolition .................... Other Work ................................................... ,~ ~,,,,~-- cr'J (Description] 4. Estimated Cost ....................... : .................................... Fee I~ (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floo~' ........................... 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, if 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 ........................................................ Name of Former Owner ...................................................... 11. Zone or use district in which premises are situated .................................................................................................... 12. Does proposed construction violate any zoning Iow, ordinance or regulation: ....................................................... 13. Will tot be regraded . ........................... Will excess fill be removed from premises: ( ) Yes ( ) N 14. Name of Owner of premises .................................................... Address ................................ Phone No ..................... Name of Architect .............................................................. Address ................................ Phone No ...................... Name of Contractor ............................................................ Address ................................ Phone No ...................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether exi~-tlng or proposed, and indicate all set-back dimensions 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, IS S COUNTY OF ...~.~-..-~:.~..~...~.'>.~. .......... ~ ' .............. ....................................................... oe ng duly sworn, deposes and soys that he is the pplicam (Name of individual signing contracf) o'bove named. ~qe is the ............. .~?....~2~...:.¢?x%.(..e~ ............................................................................................................................................ (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 that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ................. of ....... ................... , ,, 1, Notary Public, ...~~..~-~>,,,~... County .... ~.....~....~'l........,k~...; ....... .C.~ .......................................... (Signature of applicant)