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Home My WebLink About6358-zTOWN O~ SO~THOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N, Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6358 Z Permission is hereby granted to: ....... C~z~...~ ......... ~..6-..~.~.(.../~.~....~.~/.~..J ......... ............ .R.,9...~'..'.;.~;. ...... ?~??.~.;..o..~: .~.;~.~ .... ~,~- ,PPI ~ ~'x '/-,- ,./6.9 pursuant to application dated ................................ ~......~..4~..~: ..... 19.7...~...., and opp;oved by the Building Inspector. Fee $..J.,2 ................ - Building inspector~ FOI~I~ ~'0. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Fxamined ....................................... , ]9. Approved ....................... ..~.....~..~.., 19~. Pemit No....~...?...~.....~ .... (Building Inspector) Application No. (¢`~ ~A'~/' Date INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted ~n triplicate to the Building Inspector, with 3 sets of plans, accurate plot Can to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or pubhc streets or areas, and giving a deta ed descr pt on of ayout of property must be drawn on diagram which is part of this application. 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 a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. : e. No building shall be occupied or used in who~e or b part for any purpose wl~atever until a Certificate of Occupancy shall have been granted by the Budding Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuanc~ of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffoll~ County, New York, and other ap¢ic~b[e ,Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for 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 inspections. (Signature of applicant, or name, if ~ corporation) State whether applicant is owner, lessee, agent, architect, engineer, geneiaJ contractor, electrician, plumber or builder. Name of owner of premises ..~./~.Z~:~.~..: ....... ,. ......... :/~..~,.;.....~.~: ...... .'...~....~..Z. ..................... If applicant is a corporate, signature of duly authorized officer. (Name and tide of corporate officer) 1. Location of land on which,;?~,; proposed work will, ..-~be done.., Map/No./:/.'.,%1.(:~'./.~..:.'¢¢ ~- >¢~ / /..,.~' ~/¢ c kotNo .... ~'/.~-:i.:!,~ ¢" ............. '~/' 6-~/'J'~2":: ....... ; ...... Street and Number ~.~.;~..:..).~.~.J.../~.~..~:/..~.:~./'¢~.~'.~.~./..£`.~./.¢q~.~.~..~.'.~'~.'~/`. ....... ~.:"..~...~ ..................... Municipality 2. State existing use and occupancy of premises a/r)d intended use and occupancy of proposed construction: a. Existing use and occupancy Y' b. Intended use and occupancy .................................................................................................................................. 3. Nature of work (check which applicable): New Building ....................... Addition ....~- .............. Repair ......................... Removal ......................... Demolition ........................ Other Work .... 4. Estimated Cost ............................................... Fee .................................................................................. , ............. (to be paid on filing this application) 5. If dwelling, number of dwelling units ................. Number of dwelling units on each floor ......................................... [f 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 ........................................................ /~0 9. Size of lot: Front ................ /......~......u.. ........ Rear Depth Height .................................................... Number of Stories ...................................................... 10. Date of Purchase ............................. Name of Former Owner ......................................................................... 11. Zone or use district in which premises are situated ........ ................... ~[~(.~..~l ~.~ 12. Does proposed construction violate any zoning law, ordinance or regulation: 13. Will lot be regraded ..................................... Will excess fill~e removed from premises: [ ] Ye! [ ] No · ' ~ ~'~ '~'~-~/ Phone~'"d~" ,.~,.,No.) .................. 1,,. Name of Owner of prem,ses i:~'~i;;';;i ................................... Name of Architect .................................................................................................................. [;~'~'~'~i ............... Name of Contractor ........ --~....'.....~¥.:.Z ................................................................................. ' .............. (Address) Phone No.) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-~ property lines. Give street and block number or description according to deed, and show street name er interior or corner lot. STATE OF L ~ COUNTY OF ................................................... EANL ~/'lr Ik('~ E B~ R ~ being duly sworn, deposes and says that he is ti (Name of individual signing contract) ................................................................................................................ 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 and statements contained in this application are true to the best of his knowledge and belief; and that the work will set forth in the application filed therewith. ................................ o, .................................... (St ,o .... Notary Public, . .................................................................... County Alteration.¢ ............. (Description) ~ck dimensions from and indicate wheth- applicant hbove named· e this application; that all performed in the mannel