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Home My WebLink About5906-z FOI~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISE: COMPLETION OF THE WORK AUTHORIZED) 5906 Z UNTIL FULL Permission is hereby granted to: ..... ~....i~ .~..~..~?~. ........... ..... ........... ........ ..~....~.,e.~.,.~....Z~.,.~.,..:.J:!~!..~ ....... ............................. l~Xe.e.~.. Ae.~]~,.....~.~'~e. ....... II.~..,.....~ .................................................. -~ 'i:~' pursuont to opplicotion doted .................. ~.~..' .... ...,,. .~ ,, 19 i'., ond opproved by the Building Inspector. Fee ,.~.~r.,.~.....: ..... i iici' g jspect7 " ^__4,.~pproveu .................... !! .................. , FOI~I N~. 1 TOWN OF SOUTHOLD BUILDING DEPARTMEN~ TOWN CLERK'S OFFICE SOUTNOLD, N. Y. Application No..Z.~....O....~. ................. Disapproved a/c .............................................................. ~ APPLICATION FOR ~ PERMIT Date ........ .~.~ . ~&Y .. , INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and ~ubr~itted in triplicate to the Building Inspector, wit 3 sets of plans, accurate plot plan to scale. Fee accordmg to schedule. b. Plot plan showing location of lot and of buildings on premises, relationshi~ to' adjoining premises or public streets or arees, ancl~ 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 ~f B~Hding Permit· O d. Upon approval of this application, the Building Inspector wdl 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 whole or in part for any purpose whate~'er until a Certificate of Occupancy shall have been granted by the Building inspector APPLICATION IS H~R[BY MAD[ to the Building Department for the ~ssuanc~ of a Budding Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk Count,/, New York, and other applicable I_aws, Ordinances or Re§ulations, for 'the construction of buildings, additions or alterations, or for removal or demolition, as here~n describe0. The applicant a§rees to comply with all applicable laws, etch nances, building code, housing code, and regulations and to admit authorized inspectors o? premises and n buildings for necessary inspections. (Signature ~applicant, or name, if a corpo~-a"tion) 210 Sout~l/ Wellwood Avenue · .Lind chh.ur s.~.,...~.e.~...~.o.rk...1.1.7~ 7 ......... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Owner Name of owner of premises ..... ~e.v.e~d..J/ay.~o~d..~i....~nge~t~...i ......................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) ~,/' Fl~e~s l~eck Estates ~ Location of ~and on which proposed work will be done. Map No.: (~p. tc.h..o.~u.q ~. N.Y. Lot No ............. Municipality 2. State existing use and occupancy of premises and intended use and occppa~cy of proposed construction: same b. In~ended use and occupancy ........................................................................................................... 3. fqature o'f work (check which applicable): New Building ....................... Addition ..................... AIteration,,~,,,.~;.;.:,,. Repair ......................... Removal Demolition Other Worl4)~.na~e~t a.],.:~,e a~ e ................................................. IDescription) 4. Estimated Cost .....a..~..o...u..t....~.~..0..O..t..0..0. ............. Fee .., .......................................................................................... (to be paid on filing this application} 5. If dwelling, number of dwelling units .................Number of dwelling units 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. 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 ........................................ r)imensions of entire new construction: Front .........................Rear ............................ Depth ................................. Height ..--~,.,'...~.~.~5.¢....~.!'......~..0......~.0.~t[. ~l~r~Ft~C~...,0.~t~,l~ext/;a.]...£.el~-C~e..~oz'....P~.~..~&e~'' ~e~ Size of lot: Front ..... £OJ~ ......................... Rear ...... [1~ ............................. Depth .,.-.1.~..~ .................................... [)ate of Purchase .....[..9.,6. 3,. ...................... Name of Former Owner .....~.~e[e.l;.....~.t;~,~;P- ........................................ Zone or use district in which premises are situated ...................... Z'~."...?,./..~..~., .... Does proposed construction violate any zoning law, ordinance or regulation: ............................................................ Will lot be regraded .................................. Will excess fill be removed from premises: [ ] Yes [ ] No Name of Owner of premises ........ .o...~.....~..e.y..e..~..s...e. ....................................... 8..8...4...-.~..0...4.,6. ...... (Address) (Phone No.) Name of Architect .......................................................................................................................................... (Address) (Phone No.) Name of Contractor ................................................................................................................................................... · (Address) (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 number or description according to deed, and show street names and indicate wheth- er interior or corner lot. '~9. 10. 11. 12. 13. 14, STATE OF NEW YORK, ) SS COUNTY OF ......................................................) .......................................................................................................... being duly sworn, deposes and says that he is the applicant above named. (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 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. ...................................... dayof .................................................. ,o ............. /? /'2 -I Notary Public ..................................................................... County .............................. ..~,,~;,.,,~ ....... I~...~.;,,,,~ ......................... ~ignature of applicat[u