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Home My WebLink About6902-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 PI~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 6902 Z Date ...................... Oc.tohe~. ......... 3 ..... , 1~3~... Permission is hereby grc~nted to: Tw/z~ ..F~uae .. C o..... ~/.C ..... Paul..-- ~er~ a-. ~.,.W-i fe M~ttituck ereet and mainta~ .~..~..$ .~h.,~Lu.. li/~k £.e~e at premises located at ..19~O.....Llh.t2~e...~.~ck.-P~..~ils~n..Road?. ........................................ Cutcho/~/e pursuant to application dated .......................0.C.~ ........ ~. .............. , 1~..~ ...... , and approved by the Building Inspector. Fee $~...~.?...O~,,. ............. Approved ............ t..L. ......................... , FO~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Disapproved a/c .... ~ ......... ~ ........................................... APPLICATION FOR BUILDING PERMIT ~,e ............... .g./..~ .?.. ................ , INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildin 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 to adjoining premises or public streets c areas, and giving a detmled description of layout ofproperty must be drawn on the d~agram which is part of th~s appticatio~ c. The work covered by this apphcation may not be commenced before ~ssuance of Building Permit. d. Upon approval of thru apphcation, the Building Inspector wdl ~ssue a Budding Permit to the applicant Such perm shall be kept on the premises available for inspection throughout the work. e. No budding shall be occupied or used in whole or in pa rt for any purpose whatever until a Certificate of Occupam shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the ~ssuance of o Building Permit pursuant to ti- Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Lows, Ordinances, Regulations, for the construction of buildings, additions or a~terations, or for removal or demolition, as herein describe, The apphcant agrees to comply w~th all opphcable lows, ordinances, building code, housing code, and regulations, and ~ admit authorized inspectors on premises and in buildings for necessary inspections. ~ ......... :...L: ............ (S~gnature of applicant, or name, if a corporation) ...................... (Address of applicant) State whether applic(]nt ~s owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or buddc Name of owner of premises ...~.,,...:.~....~..~.,i° ....... i~.Z.i~ ...... ~..: .................................................. If ajppl~'cant, jisa c~ate, s,gnature of duly authorized officer. I,,,.,L I " (l',l~fnne end title of corporate officer) Budder's k~cense No ..................................................... Plumber's License No ................................................. Eleclrician's License No ............................................. Other Traders License No ............................................... 1. Location of lend on wh~c~ p/91~se~_ork/~il[he ~one. ~ep No ' . ....................................... Lot N~--..~ ................ Street and Nu~m~e ~..~..~.j~.., ............................................................... ~....~. nnumcipadty 2 State existing use and occupancy of premises and ~nten.ded t~se and .occupancy of proposed construction: a. Exisiting use and occupancy..~r~/~.....t~.&,'~l~J¢:'.~.~ ,~,.....~, ............................................................. b Intended use and occupancy ...................................................................................................................... 3 Nt~ture bf work (check which apphcable): New Building .................. Addition .......... ~1 ....Alteration ... Repair .................. Removal .................. Demohtian ............... Other Work ...... ¢-d~,~.v.~.~ . (De~r ipt~on) 4 Estimated Cost .....................~. ~.~..:...~....D. ................... Fee ........................ ~...~..-'~.. ~..~.. ................................... (to be prod on filing th~s apphcahon) 5. If dwelhng, number of dwelling units ................... Number of dwelling units on each floor ....................... If garage, number of cars ................................................................................................................. 6. If business, commercial or m~xed occupancy, specify nature and extent of each type of use ..................... 7 D~mens~ons of existing structures, if any: Front ........................Rear ................................ Depth .................. Height ........................ Number of Stories .......................................................................................... D~mensions of same structure with alterations or addmons: Front .................................... Rear Depth .............................. Height .................... Number of Stones ................................ 8. Dimensions of entire new construction: Front ................................... Rear ............................ Depth ........ Height .................... Number of Stories .............................................................. ........ o 9 S~ze of lot. Front ..........~..'0. .................................... Rear ......................... Depth .. 10 Date of Purchase ........................................ Name of Farmer Owner ...................................... 11 Zone or use district in which premises are situated ............................................................................... 12 Does proposed construchon v~olate any zoning law, ordinance or regulation ....................................................... 13 Wdl lot be regraded ......................... ~/dl excess fjII lie removed from premises' ( ) Yes ( ) No 14 Name of Owner of premisesx~ ,, ,-~ ,~_~-~ ~~.~,/.,.~.~Z~.~..,...,.~..t.. Address ......~t...?..7..?. .............. Phone No..7....-~...~..-....~7., Name of Architect ....................................................... Address ................................ Phone No ...................... Name of Contractor .................................................. Address ................................ Phone No ...................... PLOT DIAGRAM Locate clearly and d~stmctly all buildings, whether ex~stmg or proposed, and indicate all set-back d~mens~ons fro property hnes. Give street and block number or description according to deed, and show street names and in, whether interior or corner lot ,'(- ~' ~' F ~ r v ,,, ¥. ~*,,~ .: , ,.,- ," ?- y 7-Y v" ,"_'~ ................................................................................................ being duly sworn, deposes and says that he ~s the appl~car (Name of ~nd~wdual s~gmng contracf) above named. He ~s the ....................................................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and ~s duly authorized to perform or have performed the sa~d work and to make and fd th~s apphcation; that all statements contained m th~s apphcation are true to the best of his knowledge and behef, or' tha~ the work will be performed m the manner set forth in the application filed therewith Sworn to befor~ me this ~ . . ......... /_z// / Notary Pub I i c.~..'~. ~/~. ~....~.~/~...;~.~...~ou n t y ..~4~.....~..~.. , ~xx JUDITH ?. J/ ~/(Sig~ture of apphcant) BOKEN Notary Pubhc, Sfal$ o~ N~w No 52- 0344963 SuffoJ~ County...~ Commission EXpires Malc~ 30,