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Home My WebLink About6859-z FORa~ 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? 6859 Z Fee $~ .~.QO ............. Permission is hereby granted to: · To.~...g~.~rko. sk.1.....A/.C....~...K..l~o3..q, ancl... ........... ~L~t ~i~.uc~ ............................................... to ... 2,u.J.l,d,.. a.n...~'~dd,:L.t~ ea'~ ..,~n..,ex.i.s.t~. ~§.. el~e ~.~ ~ g ............................................................ at premises located at ...[~:J;,~-.-;~4~7.-4%..~2~.....J~a.S13e~-.~t ............................................................. ............................. R~.~....~£...~n~t~n..P~ ........... /:~t~ho~ .............................................. pursuant to application dated ......................... k~.¢~; ........1.~. ........ , 19..~..~.., and approved by the Building Inspector. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ........................................ , 19 ........ Permit No ............. Disapproved a/c APPLICATION FOR BUILDING PERMIT Date ..................... Re~ ........1.~...., 19....~..~....~ INSTRUCTIONS a Tht I ~ · 's app italian must be completely filled in by typewriter or~ in ink and submitted in triplicate to the Bui d ng,~ Inspector, with 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, relationship ~o adjoining premises or public streets areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. 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 work. e. No building shall be occupied or used in whole or in pa rt for any purpose whatever until a Certificate of Occuponcy~) shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment for the issuance of a Building Permit pursuant to the 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 alterations, or for removal or demolition, as herein descri~ The applicant agrees to comply with all applicable laws, ordinances, building code, housing cede, and regulations, and to~' admit authorized inspectors on premises: and in buildings for necessary inspections. ... ~o~e~h.....Dee~,~o~k& .................................................... (Signature of applicant, or name, if a corporation) Mattituck (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. builder Name of owner o$ premises E .K .Holland If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: ...... ~a...s..s..a...~....?..o.~..~.,t. ..... Lot No~...~......~....~....i... Street and Number ....~.~...~,J~$.~..~,~a~ .............. N~S~..l~.~ ....... ~tC~O~.~ .......................................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: dwellin a. Exisiting use and occupancy ......................... ,~ .................................................................................................... b. Intended use and occupancy same with addition 3. Nature of work (check which applicable): New Building .................. Addition .....~ ........Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work ........ ' ~ ~ ...... (Description) 4. Estimated Cost ...........~..O..,..0..0...q..~ ............................... Fee ..~.~.,..0...0. ............................. 2 ............................................... (to be paid on filing this aJgplication) 5. If dwelling, number of dwelling units .......... .o..~.e. ........... Number of dwelling units on each floor ............................ If garage, number of cars ............................................................................................................................................. 6. If busi:n?s~ commercial er mixed OCcupancy, q~ecify nature and extent of each type of use ............................ 7. D!mensio~ns of e~isting structures, if any: Front ............................ Rear ................................ Depth .................... Height ~ ·' Number of Stories ................................................................................................................. Dimensions of tame structure with alterations or additions: Front Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ..... ~L2.~...2.Q ................. Rear ............................ Depth ......1..,~....2...1! ..... Height .................... Number of Stories ........ .o.~e. ...................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 1 I. Zone or use district in which premises are situated ......... .~.~.t.~...~l,~a~ ........................................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... ~ .............................................. 13. Will lot be regraded ..~...O.. .................... Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner ,~f ,,remiso* l~.o[.Ho'lland Arldr~ .. 012~(=hogue Name of Architect .............................................................. Address ................................ Phone No ........... ............ Name of Contractor 3'. De~.rko&ki Arldre-- Y,~ttt:Ltu¢l~ Phone No ....................... PLOT DIAGRAM sed, and indicate all set-back dimensions fram to deed, and show street names and indicate Locate clearly and distinctly all buildings, whether existing or prop, property lines. Give street and blOCk number or description accordin whether interior or comer lot. ' I STATE OF NEW YORK. COUNTY OF ...... .~LL~;['.Q],~ ........ ......................... .~g.&~..~.~Q~. ............................ ~...being duly sworn, d~oses and says t~t he is the applic~m (Name of individual signing contrac~ abeve name. ~ilder He is the ................................................................................................................................................................................. (Contractor, agent, co~orate officer, etc.) of said ~ner or ~ners, and is duly authorized to perform or h~e performed the said work and to ~ke and file this application; that all statements c~toined in this applicati~ am tree to the best of his knowledge and belief; and that the work will ~ performed in the manner set forth in the application filed therewith. Swam to ~fom me this Nota~ Public, . ................................................... Coun~ ..... ~...~~ ......................................... . ~ ~ (Signoture o{ o~plicont)