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Home My WebLink About6090-zTOWN 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 AUTI-IORIZED) ; N? 6090 Z Permission is hereby granted to: ~.~..F~ ..r~r~e.. ¢0 :a.~.. C ta~ ................... ,J~a.t~J:.~t~ek ..................... ! ................ at premises located at ~J~..~..a;.~J~ttJ~,, .-~lJ~--.- ........................................................ ................................................ ,.~.~.~l~l~ ....... ll,:go.. ............... ' ......................................................... pursuant to application dated ............ ~ ............... ~ ~t~.....~.'J~//',.~J~lg.~Jj...,~and approved by the Building Inspector. Approved FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMEN~ TOWN CLERK'S OFFIGE~ SOUTHOLD, N, ^pp,co,o, ................. Disapproved a/c ............ ; (Bui ding nsp~J~or) APPLICATION FOR BUILDING PJERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationshi ;Jbmitted in triplicate to the Building Inspector, wit} to adjoining premises or public streets or areas, am giving a detailed description of layout 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 c~f Budding Permit· d. Upon approval of this application, the Building Inspector will issue a BuiJdinfl] Permit to the apphcant. Such permit shall be kept or the premises available for inspection throughout the work· e. No building shall be occupied or used In whole or in part for any purpose wl~atever until a Certificate of Occupancy shall have been granted by the Building 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, Suffotl~ County, New York, and other applicable iLaws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as her~in described· ~he applican~ agrees to comply with all applicable 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 a corporation) ... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. · C~a~o~' .................................................................. : .................................................................................................... Name of owner of premises ~..~.,...~..~g..~a~.Jg~...~., ..................................................................... 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.: ........ i ........... Lot No .............................................. Street and Number ,...p~.ne...TJ~j~,~..~,~.el.~....~...~tt~o~¥..~OW..~,~~ ................................................................... i Municipality 2. State existing use and occupancy of premises and intended use and occt~pancy of proposed construction: a. fixistin§ use and occupancy "~0~',' ................................................ i- ...................................................................... b. ·Intended use and occupancy .................................. l' ......... ¢ ......... ~ ................. ...................................................... i o 10. 11. 12. 13. 14. Nature of work (check which apphcable): New Braiding ....................... Addition ...................... Alteration ............. / Repair ......................... Removal ......................... Demolition ........................ Other Wo~k .l~ellete ........ ~. ............. ('~escriptiln) Estimated Cost .... J~l~eil~qll~. ......................... Fee ..... &.~,O,~ ........... , .............. ~ ......... ; ......... ,. ................................ (to be pale on fi ing this appdcationl If dwelling, number of dwelling units .................Number Of dwelling units on 6ach floor ......................................... If garage, number of cars ............................................................................................................................................ If business, commercial or ,mixed occupancy, specify nature and extent of each type of use .................................... 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 Storms ........................................ · I Dimensions of entire new construction: Front ................. Rear .(. _~...~.l...~.....t.. Depth ............ Height ..?..°....t3:~...~.°..°.~.~..~. .............. Number of Stories ........................................................................................ Size of lot: Front .;~1~:~ .............................. Rear .21~6 .................................. Depth ..2.~.._~ ........................................ Height .................................................... Number of Stories ..................................................................................... Date of Purchase ..................................... Name of Former Owner ...lao.l.l.et, t~ ......................................................... Zone or use district in which premises are situated ...~ .............................................................................................. Does proposed construction violate any zoning law. ordinance or regulation: 13.(t ...................................................... Will lot be regraded ................................. Will excess fill be removed from premises: [ ] Yes [ ] N Name of Owner of premises ~'C'a'R'~~rg~e~J~'~)'~/'~3~h~R~'~ ..................... (Add~ess) (Phone No. Name of Architect .................................................................................................................................................. (Address) (Phone No Name of Contractor 'i~'~;~ property lira ._.__er-~nt~or or ~rly and distinctly all street and block nu ~.~ ~ilLOT DIAGRAM #i~e? existing or proposed, and indicate all set-back d tber or desc~ng to deed, and show street names and i, ? OhS from STATE 0 ) SS COUNTY OF .! ) ..... ?..~.,,(~,.,.~.~.,,~..,~...?.~[~.~,~...,~, ...................................................... being duly sworn, deposes and says that he is the applicant I (Name of irldividual signing contract) . He is the ..~g.~. ............................................................................................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly ~ho. rized to perform or have performed the said work and to make and file this applic. statements contained in this ap~iea~jq~.~ht.¢u~ to.l~he best of his knowledge and belief;.and that the work will be performed i set forth m the apphcat~on fde~the?ewJ.t~0..~... ' ', . .~ Notary Pub' ' .......... ~.~ ./. .... ~~~ u y ~ ($~~.-.~......" ............... .... 3ove named. ~tion; that all the manner