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Home My WebLink About6345-z FOH~[ NO. ~ TOWN OF SOUTHOL;D 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? 6345 Z Permission is hereby granted to: ............ '~dw.. ~..LFdi~....~¢~ .......... ; ................ · .... :~:Lekha rr~..2~v.e ................................ i ................ ........... · }~a-~ ¢:~: ~,~l~ ........ i .................... ................ to :...;erac.t ..a;~4t...~a.i. rt.~a.i.~...a .- ~:~-e..-ya.~J... ~'~n~e...~ 6~ t... ~-boe~av~.~.) ............................. at premises located at ....~./.(~...~.¢.~k~f~.t~z..&.v.~, .......................... ~ ......................................... ~ .............. ............................... ~..t.t:;t~ck ............... .......... ~ ...................................................... pursuant to application dated ....................... ~D,.~; ......... ~..~:...., 19~...., and approved by the Building Inspector. Fee $...1.~.~ ~ :O.C} .......... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined Approved 19 ........Pemit No. Disapproved a/c ...._...~~~~.~.~ (Building ~p,~toZ APPLICATION FOR ~ PERMIT ,/~ (/ Date ..~..~.~....'?.....z.~ ........... , 19~)....~ INSTRUCTIONS This a~lication mu~t Be com~[ete[~ {i[le~ m b~ Wpemriler m in ink anO sBbmitted in triplicate to the Buildin~ Inspector, wit~ 3 sets of plans, accurate plot plan to scale. Foe accordin~ to schedule. b. ~lot plan show[n~ location of lot and of buildings on ~rem[ses~ relationshi~ to adioinin~ premises or pubhc streets or araas, ~iuinfl a detailed description o~ lagout of pro~ertg must be drawn on d~a~ram wh ~h is part of this apohcation. c. The work eouered bg this a~lication ma~ not be commenced before ~ssuance of Buildin~ ~ermit. g. ~¢on aCproua~ o{ this application, the Buildin~ Inspector will issue a Buildinfl Permit to the a~licant. Such ~ermit shall be kept on tho ~rom~ses available for inspection throughout the work. e. ~o buildin~ shall be occupied or used in whole or in part for an~ purpose whatover until a Certificate of Occuoanc~ shall haue ~ran~ed bg tho Buildin~ Inspector. ~PPklCAT~O~ IS H[B[BY MAD[ to the Bu[Idm~ Department for the [ssuanc~ of a Bu[Idin~ ~ermit pursuant to the Buildin~ Zond Ordinance of the Town of Southold, Suffoth Countg, ~ew York, and other a~plicable Caws, Ordinances or ~e~ulations, for the construction of buildin~s~ additions or alterations~ or for removal or demolition, as herein described. The applicant a~rees to compl~ w~th all applicable laws, ordinances, buildin~ code~ housin~ code, and re~uladons, and to admit authorized insoectors on ~remises and in buildinos for ne~ssar~ inspections. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................. ................................................................................... : ........................................................................ Name of owner of premises . .~. ....~. .... ~ ................................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ......... ~ .......... Lot No .............................................. Street and Number .................................... .~..../.~.'~../~.~.P'./....~..L~'..~....~...;..~..~/..~..,T..~!..?Z....~...q.,(~ ..................................... Municipality 2. State existing use and occupancy of premises and intended use and occu'pancy of proposed construction: a. Existing use and occupancy ..... ./...;..-~L: .................................................................................................................... b. Intended use and occupancy ..~'~'.~i'.~:~ . ............. ~ ..~....: ................................................................. Nature of work (check which applicable): New Building ....................... Addition ..................... Alterationi:....~.,....~. Repair ......................... Removal ......................... Demolition ........................ Other Work ?.~. :~..(../.....'~.~..~.~. (Description) (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, if any: Front ........ '~..../...:.... Rear ...... ..c~....~.....~ ......... Depth .... Height ................... ~.~...c~.. ................................ 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 ........... ../...c~.~....7....... .............. Depth Height ..................................................... Number of Stories ..................................................... 10. Date of Purchase ...... .~.~.. ........................ Name of Forme Ow ......... ; ............................. 11. Zone or use district in which premises are situated ........ ../~...~...~..: ................................................. 12. Does proposed construction vio~ate any zoning law, ordinance or regulation: ..... ./.~ ................ 13. Will lot be regraded .................................... Will ex.cess fiji be. removed from premises: [ ].Ye Name of Owner of premises ~.¢/~Z.c~¢~. V. ~...~.6t./...~ ~.)..~..~. J~ . ~.Ji~J/~L ~..~...J~..~ 4. (Address) Name of Architect ..................................................................................................................... (Address) Name of Contractor ................................................................................................................... (Address) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-I property lines. Give street and block number or description acc?rding to deed, and show street name er interior or corner lot. . ~Na~ oJ~d~al s~(*ing contractJ X X He is tha ................................................................................................................................................................... [Contractor, agent, corporate officer, etc.} o{ said owner or ownors~ and is dulv authorized to ~rform or hau~ ¢orformod tho said work and to make and f ~tatements contained in this a~pHcation are true to tho bast of his knowlod~0 and ~eliof; and that tho work will set forth in the application filed therew~ T[~RI L~E E~K ~-7' ~ARY PUBUC, State of New ...................... ........ ........... .................. / {Si~ature ofappl~ ck dimensions from s and indic~ate wheth- ~e applieant'~Poue amed. le this application; that a performed!in the mann~