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Home My WebLink About6630-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (TI-IlS PERMIT MUST BE KEPT ON THE P]~EMISES UNTIL FULL COMPLETION OF THE WORK ^UTHORI~ED) N? 6630 Z Permission is hereby granted to: ..... .~.~.~....../.. ...... ~.~........~:..~.~.~ ..... ............ ,~...Z...~. ....... .,..~..¥.~.~.~.~ ............ ~ ................................. :..~,.A...~../..~.~..~... ~/~s = ~o ..... ~.~.~-..c...~ ............. ~. ...... .fi.~:...~.~.~ ........................ .,.(.,'.:~. .................................................... .................................................................................. ~.~/...,..m...~.c..r.~.. ...................................... .... ~..q.7.. ....... ~.~ ................... ..~..Z.~T~ ........ ~.~*...C ....... ~.~£(..<. ........ fi...S...Z.~.Z..~: ............... pursuant to application dated ............................... ..L/'.......~...~....~...~....., 19~.-.~.., and approved by the Building Inspector. Fee $...L..~..~ ..... Building Inspector F. /10.00"' = ,~0<~0 ,~?. THE- RES ,ti OR/W:- 6ARY ~-T'TLEi'~YF_..R ~ V,Rr.,INIA ETTLE~YC-R LOT' 15 ~'DCFp HOL~ r...P, EEK ESTATES FOltM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .............. ..~,.. ..... ~.., 19.......77 ~ ~3 O ~'~"/~' 7~' ~'"~"~ ~ Application No ............................... Approved .................. '~17., 19 ........ Permit No ..................................... Disapproved a/c ........... ..~...' ......... ~ ..................................... ................................................................ ........ ....... ............ .~....~c. ...... .~ .,~...~ ............................. (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ...... ~...~ ...................... ~9..?..g.... INSTRUCTIONS a. Th~s application must be completely filled in by typewriter or .n ink and submitted in triplicate to the BuiJdin. Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buddings on premises, relationship to adjoining premises or public streets o areas, and giving a detailed description of layout ofproperty must be drawn on the dmgram which is part of this application c. The work covered by th~s apphcahon may not be commenced before ~ssuance of Building Permit. d. Upon approval of thru apphcotion, the Building Inspector will issue o Building Permit to the apphcant. Such permi shall be kept on the premises available for inspection throughout the work. e No budding shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupanc, shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Budding Department for the ~ssuance of a Building Permit pursuant to th, Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described The applicant agrees to comply with all apphcable laws, ordinances, building code, housing code, and regulations, and tL admit authorized inspectors on premises and in buildings for necessary ij~ipections. _ ........ ....... ......... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electncmn, plumber or builder. ......................................................................... .............. ..... " ...... : ....................................................... If opplmant is a corporate, signature of duly authorized officer. (Name and htle of corporate officer) Builder's License No ..................................................... Plumber's L~cense No ................................................. Electrician's License No ............................................ Other Trade's License No ............................................... '~) ~j~'~ (/~:j~ ~-'~'~-~ Location of land on which p. ro~osed work w~ll bm,fane Map No: .............. Lot No Street and Number ......... b.~...~....~~.~.~ ........ ~....~.~~..~'~....i ..'i.iii ............ Municipality State exishng use and occupancy of premises_and, intended use and oc, cupancy of proposed construction: a Existtmg use and occupancy ........................................ ~ ............................................................... b Intended use and occupancy ....................... ~ ..................................................................................... 3 Nature of work (check which applicable): New Budding .................. Addztlon .................. Alteration ...... Repair .................. Removal .................. Demolition ................. Other Work ........................ : ...................... (Description) 4. Estimated Cost / /' Fee (to be pa~d on filing th~s applicabon) / 5 If dwelling, number of dwelling units ............................ Number of dwelhng umts 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. D~mensions of existing structures, if any: Front ............................ Rear ................................ Depth ............. Height ........................ Number of Stories ................................................................................................ D~mensions of same structure with alterations or addmons: 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 construcbon wolate any zoning law, ordinance or regulation .......... -J.~. ..................................... 13 Wdl lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes .[ ) No 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 d~st~nctly all buddings, whether ex~sting or proposed, and red,cate all set-back d~mens~ons fror property hnes. G~ve street and block number or descnpt~on accord,ng to deed, and show street names and ind~cat whether interior or corner lot STATE OF NEVV/Y0~K, COUNTY OF- '.: ................. : ...... ' ' '/ ........ being duly sworn, deposes and says that he ~s the apphcar (Name of individual signing contract') above named. He is the ................................................................................................................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the satd work and to make and th~s application; that all statements contained ~n this apphcat~on are true to the best of his knowledge and belief, an that the work will be performed m the manner set forth m the appli~;at, ion filed therewith Sworn to before me th,s / (Signature of appli(~nt)