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Home My WebLink About6919-z FOEM NO. 2 TOWN OF SOUTHOLD BUILDING DEFARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 6919 Z Permission is hereby granted to: to ..EL~c:b. Jnd..maint~_t_~..a..aida..~ard..fanae.....6/:t..hiSk..on.Ea$~..P.,L, .......... at premises Iocate~ at .... .N.../.,~.......,~...~....R.?.~.....~..~..~....I~,a..?.~ ......... ,.~..?..Y..; .................................... ........................ (.~.~.e.....~...A~.~.). ............................................................................................ pursuant to application dated ...........................~.~ ....... ~'$""r ..... , 19~/,.~..., and approved by the Building Inspector. Fee $ .~1.~,.~(~. ........... FO~,~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ......................... ................................. Application No...~..~..(.~.. ................. INSTRUCTIONS a. This apphcat~an must be completely filled in by typewriter or in ink and submitted m 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 adloimng premises or pubhc streets o areas, and giwng a detaded description of layout ofproperty must be drawn on the diagram which is part of this application c. The work covered by this application may nat be commenced before issuance of Building Permit. d. Upon approval of thru apphcation, the Building Inspector w~il ~ssue a Building Permit to the apphcant. Such permJ 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 whatever until a Certificate of Occupanc: shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to th, Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described The apphcant agrees to comply w~th all applicable laws, ordinances, building code, housing code, and regulations, and t, admit authorized inspectors on premises and in buddings for necessary inspections. .... . h./......./..J, ............... ( (Adc[tess of appli((ant) State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ........................... ......... .............................. .................................................................................................. Name of owner of premises ...,'~....~.l,~ '~/.~ ........ ~.~.~ ...... l~. ~~ C~r3., .~r .~..f.~ .............................................................. If apphcant is a co~orate, s~gnature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's L~cense No ................................................. Electrician's License No ............................................ Other Trade's L~cense No ............................................... 1 Location of land on which proposed work will be done. Map No:' . ....................................... Lot No ........................ Street and Number .... ..~.~K~.*.~....,[~.~.1. ................... ~.,¢:4¢~.,,,,,.',J,~:],~C¢.,.~'r,<'g~ ................................................... Municipahty 2. State existing use and occupancy of premises and m.*ended use and occupa_ncy of proposed construction: a Ex,sit,ng use and occupancy ........... D ~.~&,...~/~.3.~'.....~.. ....... '~' ~-//"~J~'~'"" ..... '"~3"'~ ........................................ b lntendeduseandoccupancy ......... ~..~~9,~/~/~--/ ~......~'~..-:~-~~'~ ............ Alteration . .. 3 Nature of work (check wh,ch applicable). New Budding ................. Addition .~. ~ Repair ............ ~ ....Removal .................. Demolition ................... Other Work--¢~.~x~......~.~.~....~... (Description) 4. Estimated Cost f....~....~...?'...~......c.. ~ .............................. Fee .............................................................................. (to be pa~d on filing th~s apphcation) 5 If dwelling, number of dwelling units ........................... Number of dwelhng umts 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 Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth ................ Height ........................ Number of Stories ..................................................................................................... Dimensions of same structure with alterations or add~ttons: Front .................................. Rear ........... Depth ............................... Height ....................... Number of Stones .............................. 8. Dimensions of entire new construction: Front .................................. Rear .......................... Depth ............ Height .................... Number of Stories ...................................................................... 9 Size of lot' Front ........................................................ Rear .......................................... Depth ....................... 10 Date of Purchase ~.[~tz~,.~. ............... ~[.~..~.'~. ........ Name of Former Owner~lT~.~.~.l.~ ..~.~ ~:z~.~. ..... 11 Zone or use district in which premises are s~tuoted ..................................................................................... 12 Does proposed construction wolote any zomng law, ordinance or regulation ...................................................... 13. W,II lot be regraded ....... ..~.~., ........... W, II excess ~:,11 be removed from prem,ses ( ) Yes (~o 14 Name of Owner of prem,ses~;l,~/4... .~J ...... J./].~l~/~.ct AddressL"~....~.l~,4~/~'~'~ ...... Phone No.~..Z:T.~../...~..' Name of Architect ............................................... ~ ....... Address ................................ Phone. No ..................... Name of Contractor ......................................................... Address ................................ Phone No ..................... PLOT DIAGRAM Locate clearly and d~stmctly all buildings, whether ex~sting or proposed, and red,cate ail set-back d~mens~ons fror property lines. Give street and block number or description according to deed, and show street names and ind~cat whether interior or corner lot. STATE OF NEW YORK, ~-S.S ~ . , COUNTY OF ............................~ ~ ' .............................................................................................. being duly sworn, deposes and says that he ~s the apphca.~ (Name of indtwduol signing contract) above named. He is the ............................................................................................................................................................... (Contractor, agent, corporate officer, etc) of sa~d owner or owners, and ~s duly authorized to perform or have performed the sa~d work and to make and this application, that all statements contained m th,s apphcation are true to the best of h~s knowledge and behef; an tk, a~ the work w~l be performed tn the manner set forth tn the apphcot~on filed therewith Sworn to before me this ........................ day of ........................................... ,19 ....... > ./ ~/ /~/,¢.~'~,.~ ....~ ~../~- ~./..*. Notary Pubhc, . ................................................... County .... // (Sj~hj~ture of applicant)