The URL can be used to link to this page

Home My WebLink About6925-z FORM NO. 2 TOWN OF SOUTItOLD BUILDtNG DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING prER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 6925 Z Building ~ I,specto~r. Fee, '~er ~J~": .......... Permission is hereby granted tO: ,-J~L~jae~..~..4t~;~tt .~t~J .......... .~l~,1,~...~e~,~k .. ~ ~ ............................ .~eeeater.li~..l:., ........................................ to.~e~~t~e~i~aaee~anee.~J`tb~p~ie~;e~t~E~v~J~/~?~.. ................................................................ :.~.2;..L...~.:.. /.? ............................... : ........................................... at premises located at .,,~.JJ:.~..~J~J,.,.O~..~./.~,~-..,.,.o~.~.?.~..~..~.?......~....e....~ .............. ............................ ~ ............. ~/~',t~,'l,.~Le.., e~.. IJ.~..~e ..~...m:ro..~o3.A ....................................... ........ : ....................................... :.i. ................... ~ ...... ~.~.; ............................................................................... pursuant to applicati6r~ datec~ ...... '...~1[~.~,1~..~ ..... '...'.~ .......... , 19..~L., and approved by the '~,~i ....... Il FOB~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ................ .0..¢.~9.1~.~.:7....~,~,~ 19]~... Application No ................................ ~proved ........................ E ......... &5, 19.~3... Permit No. ~v.../...~ ............ZJ. ..... ~-'~' ~ D~sapproved a/c ............................................................................................ ~ ~ ~ .............................................................. ............................... ................ ....... APPLICATION FOR BUILDING PERMIT Date 0a~ober 1~' · 19......2..3.. INSTRUCTIONS a This apphcat~on must be completely filled in by typewriter or in ink and submitted m triplicate to the Buildln, 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 o areas, and g~wng a detailed description of layout of property must be drown on the d~agram which is part of this application c. The work covered by th~s apphcation may not be commenced before issuance of Building Permit. d. Upon approval of th~s application, the Building Inspector will issue o Building Permit to the applicant Such permi shall be kept on the premises available for inspection throughout the work. e. No budding shall be occupied or used in whole or ~n part for any purpose whatever until o Certificate of Occupanc' shall have been granted by the Budding Inspector. APPLICATION IS HEREBY MADE to the Budding Department for the issuance of a Building Permit pursuant to th Budding 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 describe, The apphcant agrees to comply w~th all apphcable laws, ordinances, building code, housing code, and regulations, and t, admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applica~rname, if a corporation) Box 111~ NOrth Rd.~ Peconia~ i. Y. (Address of applicant) State whether applicant ~s owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or buHde, ..................... ~ .o.~.-.~,~. ~, .,'~..~ ~.. ?z.e. ~...~. ,... ~..~ .e...o.b...s. ~....~ .o..~...V.e....~.. ~.t....~..s..s. .................................................................... Name of owner of premises ........ ~J~Lg~t~...~.~.D. ............................................................................................................ If applicant is a corporate, signature of duly authorized officer. .................. .z...zt~.¥$..~.~.z. ............................................. (Name and t~tle of corporate officer) Builder's License No ....... ~.~.~ ............................. Plumber's License No. ..~~ ............................. Electrician's License No..~ ............................. Other Trade's bcense No ...... :Y~,~g~.[ ........................ 1. Location of land on whmch proposed work will be done. Mop No. :y-Dr.~ Lot No. :z::y~::o:~ Street and Number ..O.~...~..~.:....b..e..~.~...e..e...~...?..¥.~.:...~.~ ~.......O..a...~..o...1..e.....~...~.e..¥..e.?..~Z ............... ~.o..~..tg.~..o..Z...c]. ........... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a EXiSltlng use and occupancy ..... ~.o...~..~..~ ..................................................................................................... b Intended use and occupancy ..... ~.c~Ln_~...i.zi.'b~..c.o~.~i~.~&tz, i~q....o~'...:~eztce...o~..tf~$L~B...~ .......... Beverly Rd~ and If/side of Old Cove Rd. 3. Nature of work (~he'~ck ~vhich applicable). New Bu~ld,ng .................. Addition ...............Alteration ... Repair .................. Removal .................. Demohtlan .................. Other Work Fence 4. Est,mated Cost ............ .~.0..C)......O...0. .............................. Fee ...~..~.t..O...0. ........................................................ (to be paid on filing th~s application) floor .................. 5 If dwelling, number of dwelling units ..... ~ ............ Number of dwelhng umts on each ~-~-_~_~c If garage, number of cars 6. If business, commercial or mixed occupancy, specify nature and extent of each type of u~e~.~..~..~.~.~..~. ....... 7. Dimensions of existing structures, if any: Front ..~-~-r,.~c~:c. ............. Rear ..:~O~,~:~ ............... Depth ......zf.~.~.'~ .... Height .~...:~.. ........... Number of Stories ..~.~..~..~. .............................................................................. D~mens~ons of same structure with alterations or addmons' Front .~.~.:.~ ..................... Rear Depth ............ ~.).! .......... Height :Y~]~' Number of Stories XX::C~ 8. Dimensions of enhre new construction. Front ..... .:~.~..:z:~ ................... Rear ........ ~:.~ .........Depth~'..~..~..~... , Height ~ Number of Stories 9. S~ze of lot. Front ...... .~.~P.~.c~..~.."...~.Z..0..~. ........................ Rear ...~..=D.~..O..~..: ..~.?.0..! .............. Depth. 80i 10. Date of Purchase ............ ~(~-.-~..~.DZ'.Q~, ............... Name of Former Owner .... .~.~..o...~ql....o.~.~ ........................ 11 Zone or use district ~n which premises are s~tuated . 12 Does proposed construction violate any zomng law, ordinance or regulation' . ..... .}.~..O. ......................................... 13. Will lot be regraded ........ .~.O. ............... Will excess f,ll be removed from premises' ( ) Yes ~ ) No 14. Name of Owner of premises ....~.~.~.....o.~.~...e..~...~..~..e. ............... Address ................................ Phone No ...................... Name of Architect ....................................................... Address ................................ Phone No ...................... Name of Contractor ...... ~.e..~ ......................................... Address ................................ Phone No ...................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ex~sting or proposed, and indicate all set-back dimensions fron property lines. Give street and block number or description accord,ng to deed, and show street names and ind~cat whether in~'erior or corner lot OF s .............................................................................................. being duly sworn, deposes and says thor he ~s the apphcan (Name of individual s~gning contract) above named He ~s the .................................................................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and this apphcatlon; that all statements contained that the work will be performed ~n the manner set fo~h in the apphcation filed therewith Sworn to ~re me this ...~LR ..... ~ ...... d~of ~.~~.~. ...... Nota~ .......... ..................