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Home My WebLink About2570-z FORM NO. 2 TOWN OF SOUTHOLD 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? 2570 z Permission ~s hereby granted to: ~leir.. &. Ho~. f,~:....A/fa ..... IlecL.8.te!zer. ........ to ...{i~:~:t~..~..~S~.. ~.. ~..e~t ~.. ~elt.~.rt~ ..................................................... at premises located at ..... .~J~.,~.,~__~_ ..... (l:~:~a~,~.jL) ............................................................... pursuant to application doted .............................. l~to:be;J'......~C~ .... 19.~.., and approved by the Building Inspector Fee $'-'-~'~00 .......... Building Inspector FOEH NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TO'~,'N CL.ERK'S OFFICE $OUTHOL. D, N. Y. ....................................... ~ 19 ........ Permit No ............ Apphcation No. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This opphcation must be completely filled in by typewriter or in ~nk and submitted in duplicate to the Buildin Inspector. b Plot plan showmg location of lot and of buildings on premises, relationship to adjoining premises or public streets ~ areas, and gwmg a detailed description of layout of property must be drawn on the d~agram which is part of thi,~ applicc t~on. c. The work covered by this application may not be commenced before ~ssuance of Buildmg Permit. d Upon approval of this applicatmon, the Building Inspector will mssue a Buildmg Permit to the applic~ant. Suc permit shall be kept on the premises available for mspection throughout the progress of the work e No building 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 BuHdmg Departm'ent for the issuance of a Building Permit pursuant to th, Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances oi Regulations for the construction of buHdmgs, additions, alterations, or for removal or demolition, as hereto described The apphcant agrees to comply with all apphcable laws, ordmances and regulations. (Signature of applicant, or name, if o corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ................................ ~.~.e..~.~,...~ .0~.~.~. ~,~..~ ~.~. ............................................................................................................ Name of owner of premises ........... .Q.e..o...~.~.e....~..~.e...]..~.e..z'. .............................................................................................. If applicant ~s a corporate, signature of duly authorized offlcer~, ..... .... ..... (Name and title of corporate officer) 1 Location of land on which proposed work will be done. Map No: ........................................ Lot No.: ..................... Street and Number ..... .2.7....,¢ .................................................. .g..k~%O~P~P,.¢. ........................................................... Mumc~pality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction. a Existing use and occupancy ......... ~.~.~C1.~ ..~4~.f~ ......................................................................................... b Intended use and occupancy ......... ~.9..~....e~. ?,....b9..~.~.e ......................................................................................... 3 Nature of work (check which apphcable): New Building .............. Addition ...,~. .......... Alteration ................. Repair .................. Remova! ............... Demolihon ........ Other Work (Describe) ................. 4 Estimated Cost ............................................................ Fee ............... ~5. ~. p~0 .................................................... (to be pa~d on fihng this apphcahon) 5 If dwelhng, number of dwelhng umts ...................... ~umber of dwelhng umts on each floor ......................... If garage, number of cars .................................................................................................................................. 6 If bus~ness, commercial or mixed occupancy, spec~f7 nature and extent of each type of use ................................. 7 Dimensions of ex~shng structures, ~f any Front 2..~.~. ........ Rear .... ~.j~t ........ Depth .....~,.6..~. .............. Height .......... ~.~.~. ........... Number of Stones .............~ ........................................................................................... Dimensions of same structure w~th alterations or add~hons Front ....... ~.~!. ................. Rear ........ ~.~..t ................. Depth ...........~.~.~. .............. Height ....... ~ ........ Number of Stones .... ~ ........................ 8 D~mensions of entire new construction Front ...................... Rear .............................. Depth ............................ Height .......................... Number of Stones ....................... 9 S~ze of lot. Front ......................... Rear ......................... Depth .............................. 10 Date of Purchase ........................................................ Na'me of Former Owner ..................................................... 1 1 Zone or use district in which premises are s~tuated ............... ..~....~.o..~...e. .................................................................. 12 Does proposed construction v~olate any zomng ]aw, ordinance or regulahonP ......... ~.O. ........................................... 13 Name of Owner of premises ..Q..e..o...~.~9....S...~.e..~,~..e.~.. Address .~.k~..O~Q~.~ .......................... Phone No ................. Name of Architect ............................................... Address ............................................... Phone No ................ Name of Contractor ~,,;~,.c~.~...~..~p%~.9.~ .......... Address .O.i.L¢.f3~.Q~,~.f~ .......................... Phone PLOT DIAGRAM Locate clearly and dishnctly atJ buildings, whether ex~shng or proposed, and indicate all set-back d~mensions fro~ property lines Give street and block numbers or descnphon .according to deed, and show street names and ~ndicat whether interior or corner lot STATE OF NE~/ Y/f~.l~/1. ) S S counTY ..... ) ....'~..~.....~....~-- --~' ' ~~ ......................... be,ng duly sworn, deposes and says that he ,s the applican above named. He is the ...~..~ .......... ~ ........................................................................................................... (Contractor, agent, co.orate officer, etc.) of sa~d owner or owners, and ~s duly authorized to perform or have performed the said work and to make and file th~ apphcahon; that all statements contained in th~s apphcahon are true to the best of h~s knowledge and belief; eh, that the work will be performed in the manner set forth m the apphcat~on filed therewith. Sworn to before me t~s ~ ~ ~ ~~ ...... ....... ..... ..... Notary Pubhc ..~~~ ......... County (S,gnature of appl,ca.nt)