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Home My WebLink About258-z FO~ NO. 2 TOWN Ok SOUTHOLD BUILDING DEPARTMENT TOWN CLER.~S OmCE SOUTH?~L[?, N. Y. BUILDING PERMIT N? Pert (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 258 Z ~ission is hereby granted to: ~ Ye'l;moz*e ...A/C..A,,G,,..]Ba,a~a~.t, me~, ....................... ........ llaTr.. ~i~ez, e..;B, ea~ ............................... at premises located at ~-S. ~,,~:tlI~K~r4~..R~I,-s.~ .... ~;~:l~t~--]~,~--~,8~1~11 ! ..... ,[~t..~ ..... .............. J ........................... ~ee~ix~t-~ ..... ~,-~ ..................................................................... pursuant? apphcat~on dated ............................ l~h~-~...~t ............. 19,.~., and approved by the Building ',Inspector Fee $.~.~ ............. Budding Inspector (~ FORM NO. z TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. �� ^� �'i� ~ �� Exonnined..../!/��l��...��.l—�lV.�,Q� Application No. .----....... ' Tz' � Au�oroved.~......—�!'L......l9....Penn� ��o� ......�°..'�./:..... Disapproveda/c .............................................................................................. ,,`,,,,,,,,,,,,,,,...^,,,,,,,,,,,,,,,,,,,,,,,,�,,,`,,,~^_,,, ..—./��'�i^�!��'.��\—��.-...//-..�� ,....—. (Bui|Jing |nspechod U APPLICATION FOR BUILDING PERMIT Dote........�. � !�� , ��. �]D�� —. INSTRUCTIONS o. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this location. c. The work covered bythis application may not 6e commenced before issuance of Building Permit. 6. 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 progress of the work. e. Nobuilding shall 6eoccupied orused in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted 6ythe Building Inspector. APPLICATION 15 HEREBY MADE to the Building Deportment for the issuance of Building Permit pursuant tnthe Building 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 a Iterations, or for removal or demolition, as herein described. The applicant agrees tocomply with all applicable |o*s/ ordinances and regulations. ................ (Signature ofapplicant, nrname, ifocorporation) � c� �� "...�.��'�^ � ^/ �\ddressnfopp|iozn��' ~~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .............�......��~~��......... ��.,^......�.�^.�~�........��........,��.. � kw � klo,nanfowner ofpnarnisws—.*��.,-�^~^.�...�� ........~,..—.............^—. |fapplicant ioncorporate, signature nfduly authorized officer. ~—^^^^^^^^^^^^^~~—^^—^~—^^^^—~^^~^ (None a ndtitle ofcnqmmtenMkcer � A l. Lucohunofland onwNwork Map No: .............................. �� . �.�� Lo� n: .,141��. .......... Street and Number .�^��,��/—..° �x��. ' ' Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Existing use and occupancy........ ...........N^........................................................................... b. Intended use and occupancy............,.......—..—....^........--............—..—...~.. 3. Nature of work (check which applicable): New Building....................Addition ........`".........Alteration .................... Repair .............. Removal ....................Demolition............... ther Work (Describe) .................... 4. Estimated Cost.. /...6.0.... .......................................Fee ..5 ....,.................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units....... ............Number of dwelling units on each floor............................ Ifgarage, 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........y ........... Rear ............................ Depth .-3's.................. Height Number of Stories � g ...................................................................................................... Dimensions of some structure with alterations or additions: Front ................................ Rear ................................ Depth .............................. Height ..............................Number of Stories ................................ 8. Dimensions of entire new construction: Front........./.!R............ Rear ..........I.R........... Depth ... ................... Height .......................a�. umber of Stories .....�`.A.'........ 9. Size of lot: Front Rear ..tS. Depth `� �3 i .. . ................. .P. . ........... ...... ......... 10. Date of Purchase ..." ("'.:.... .................Name of Former Owned ......Z... ........................................ 11. Zone or use district in which premises are situated......... ..d.C..� proposed y ng law, ordinance or regulation? �0... ' . .' ........ an 1 13. Name of Owner ofsprem premises violate an n'.:... .....Address ............................................Phone NO. .................... Name of Architect.....................'..{�._................................Address ............................................Phone NO. .................... Name of Contractor..�.............................................Address .....!? ` " �` 4".l.!�..�`...Phone NO. .................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner lot. I .I� ' 'Osf i1v� PDR �a 3' I 6b STATE OF NEE YO S S. COUNTY �OF .. ..... .........) ..................... ... ...'' ....being duly sworn, deposes and says that he is the applicant (Name of individual signing application) abovenamed. 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 file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this J! ' �1 ........d....I....... day of .........�.` ^. �. 19...�1� ( ignature of applicant) I Notary Public. ............................................................County