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Home My WebLink About6783-zTOWN OF SOUTNOLD 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? 6783 Z Permission is hereby granted to: · .~mmas.. & .~.~t~a ~a .. ~vaT. ...................... ........... P~'~..A~ra ................................................. to. l~[3.c[..a.~.&ct~itioz~..~l~.zle~z.. ~-~ ~.fm=t.~..~ml~J~...(~62.83Z~ ............................. at premises located at ...... .Y.f..Y...'..~...~..~.....~...~.Y. ......................................................................................... ~tt~tuek pursuant to application dated ............................. .A...~. ............ ~......, 19~.~...., and approved by the Building Inspector. Fee $..J.~.,...~.. ......... ...... ...... ......... . .... P ICATION FOR BUILDING/PERMIT INSTRUCTIONS ng~ a. This application must be cOmpletely filled in by typewriter or.in ink and submitted in triplicate to the Build! Inspector, with 3 sate of plans, accurate plot plan to scale. Fee aocord~ng to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjo n ng prem ses or pu.b areas, and giving a detailed description of layout ofpraperty must be drawn on the diagram which is part of th~s applicat,on..~ 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 wJJ ssue a Building Permit to the app cant. Such permil shall be kep~- on the premises available for inspection throughout the work. ' e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occuppnc~ shall have been granted by the Building Inspector. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No. ................................................ Electrician's License No ............................................. APPLICATION IS HEREBY MADE to the Building Deportment for the issuance of a Build ng Permit pursuant to the ~Builudln~.' Zon.e O~inance. of .the T. ,o~m of Southold, Suffolk Cou.n. ty, New York, and other applicable Laws, Ordinances or .~ at, l~cS, .mr tn. c?structl, on o..t. ou!!dlng?: .a~l. It!ons or alterat,ons, or for removal or demolition, as herein described. odemitaPaPt~z~Trt~.~ump~ly wire.al, app!,.ca?e.! ..a?, ordinances, bgl'l~g codg~FIl~slng code, and regulations, and to State whether applicant is owner, lessee, agent, architect, en.c general contractor, electrician, plumber or builder. ...................... ............................................... ~lf applicant is a corporate, signature of duly authorized officer. ' ' .~ Other Trade's License No ....................................... . . .... . . 1. Location of lan~d on whl~ propor~ work will be.done. Map No.:'~). ..................... ,~....~ .....Lot No...~.....~ ....... Street and Number .~'d~.~....~..~./~.....~...~.....~-R...?..7...~.....~..~.. ~..~.:~.//-/~ ~,~ ~~ "' /,.j~g,~4'f'~so/~) Municipality 2. State existing use and accuponcy of p.mmises and intended use and occupancy of prapaeed construction: a. Exisiting use and ~c:cuponcy ....~:/.~.: ............ ~ ................ .;.: ..................................................................... 3. Nature of work (check which applicable): New Building .................. Addition .......... I tlon ......... ;.......~, Repair .................. Removal Demolition .................... Other Work " --- ~e i~-~Description) · 4. Estimated Cost ...?.?~"~ ./. ..................... ·, ...................................................... Fee .~·. . . . ' (to be paid on filing this application) 5. If dwelling, number of dwelling unite ............................ 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 existina structures if anu' Front ~ .......... ~-~- ~'~' r~,,,k ~ Height ...../..~. ........... Number of Star es ....~..~-,~..,~..~..../.....~ ~.~......'~... .............................................. Dimensions of same structure with alterations or additions: Front .....~....~..~....~....'~.. ..... Rear ...~...~.?..71'...~..~...7....'~'.. Depth ~'/ .... Height ...../..~..~ ............... Number of Stories 8. Dimensions of entire new construction: Fronf .................................... Rear ......................... Depth ........................ Height .................... Number of Stories ........................................................................................ 9. Size of lot: Front .......... /..~...?'.:....'~. .............................. Rear ..../.L..'.~.~.~..~.~.. ............. ~:~.... Depth /.~..~.<::~' ....................... ~'~' 10. Date of Purchase ..... ~..~'.~,~.. ........................Name of Former Owner ......~.X~.....Z~/'~,.~.X~...~. ............ ! I. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zon ng aw, ord nonce or regu at on: .~...?.: ............................................. · 13. Will lot be regraded' .......~/..~.~ ............ Will,e, xcess fill_be removed fr, em premises: ( ) Y~es /~') No -- ,- 14. Name of Owner of premises ..?~.....~...t~......'~.....~....~...~..~....~Addres~~ ..~.....~.../~ No....~......,~.....~.......~ Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether exitting or proposed, and indicate all sat-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate wh_ether interior or comer lot. ~ IO'"'i'O 0 fo ,,'ff~,./,;"'"'-"'--. ' . ~',~/<, "-~ ~ · ...... ,.. ., : ~)V~' : · ~" -~ ,,/~. ~/.~ ¢0~45 " ' - ' '- STATE OF N~~- l e ~ ' '" :' ........................... ~~....~ .................. being duly sworn, d~oses and says t~t he is the opplicanl (Na~f Individual signing controc~ above named. ~ . He is the .............................. ~.........~ ........................................................................... ..... (Contractor, agent, co~orate officer, etc.) of said owner or ~ners, and is duly authorized to ~rform or have performed the said work ~d to ~ke and file this application; that all statements contained in this application ar~e to ,._.~S~h~f his knowledge o~ ~lief; and ~ha~ ~ ~o~ will ~ ~rfor~d in the ~n~r set fo~h in the a~lic~io~ll~ ~m to ~ ~this -- ~ I / I .................. .......... . { ~o~ ~ublle, ...................................... ~n .... } ................ 2 ............................. t,~ATJ~ [ ON 165.97 ~ ,t ~he se¥.,aZe d: ..... - faci!itie~ for .... inspected [:,~ 'i,h:~ ~ .... ~ .to be satis~'ac'cor~. ~ '~ ? ~ ,.. .__ · ii. I I' iI