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Home My WebLink About6931-z FO~ 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) N? 6931 Z Permission is hereby granted to: ,t~[~,~..~..~..~.~ .......... ..~'...q..... ~?...~......~.~..e..a..e....~, .......... ~.~.o..~..~. .............. : ................................. ~o ~.~...~...~.~.~...~..~.~.~.~..~.~ .......... ~.~9~.~...~..~..~.~) at p~mises I~ated at ~ 16 O~e~vee ~ sgo ~ , ............................................. · O~..~e~..~ ......... ~o~.~...: ......................................... ~,~,t to o~,c~tio~ d~t~ ...................... '.....~ ......... ~.~ ........ ~.~..., ~,~ ~p~o,~ ~ t~e Building I~pector. FOI~M NO. 1 TOWN OF SOUTHOLD BUILDING DEFARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. Approved ............. ............ '.,', .......... . ,:'erm,t No ...... D:sopproved ~..~ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Applicahon No. (.~...~./ .............. a This application must be completely filled m by typewriter o¢ in ink and submitted in triplicate to the Buildin Inspector, with 3 set~ of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing locabon of lot and of buddings on premises, relm~onship to adlommg premises or pubhc streets c areas, and giwng a detailed descripbon of layout ofproperty must be drawn on the diagram which ~s part of th~s apphcatior c. The work covered by th~s apphcotlon may not be commenced before issuance of Budding Pertain d. Upon approval of this application, the Building Inspector w~Ji ,ssue o Building Permit to the apphcant. Such permi 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 Occuponc' shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Bu:ld~ng Department for the ~ssuance of o Building Permit pursuant to th, Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other opphcable Laws, Ordinances o Regulations, for the construction of buddings, additions or aJterahons, or for removal or demolition, as herein described The apphcant agrees to comply with all opphcable laws, ordinances, building code, housing code, and regulations, and t, admit authorized inspectors on premises and in buildings for necessary inspections. ........... ..... ...................... (Signaturerd'~i~licant, or name, if a corporation) (Address/6f applicant) State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bu~Jder Name of owner of premises ...... .~....~...'~'~ .................................................................... If ajAphcant is a corporate, signaturej of duly authorized officer. (Nome and title of corporate officer)' Builder's bcense No .................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... Locahon of land on which proposed work will be done Map No ................................... Lot No ...................... Street and Number ..... ~,,.~ ........ I~,,~,.,,,,.,~..~,,.~, ...................... ~b~,,,,,~,~-zr~r~ .... " ~/' Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: b Intended use and occupancy ........................ . ./~/~,~...: ............................................................................... 3 Nature of work (check which applicable): New Building .................. Addition .......~...... ..... Alteration ........ Repair .................. Removal .................. Demolition ................. Other Work ~v ~' (DescrJpt~onY" 4. Estima~'ed Cost .~..,~.../....~...~.....~.. ................................. Fee ........... ~....[..~.~..~./....~./. ............................................... (to be pa~d on filing th~s application) 5 If dwelling, number of dwelling units ............................ Number of dwelhng umts on each floor ..................... If garage, number of cars ................................................................................................................................ 6. If business, commercial or mixed occupancy, spec~fyxnature and extent of each type of use ................ ./ ........ 7 Dimensions of existing structures, if any: Front .... ..~. 7......'. ......... Rear .....~...~......'. ................ Depth .~.....~....'. ..... Height ........ L.~....~. ....... Number of Stories ........ ~. ........................................ , .............................................. .j ..... Dimensions of sa~e structure with alterat,ons ~?r add,t,ons Front · ~. ~' Rear Depth ....... .~..~./. ................. He,ght ......... !..~. ............ Number of St'or~'~s'.i'iiii~iiii.i'iiiiiiiill .... ' ....... 8. Dimensions of entire new construction. Front ................................ Rear ........................... Depth ... Height .................... Number of Stories ......................................................................... S/ . 9 S,ze of lot' Front ....... L.~..Z.~./. ............................... Rear ...,~e,r~. ................... Depth. /..~..~.,..~.'. ..... 10. Date of Purchase ...................................... Name of Former Owner .................................................. 11 Zone or use district in which premises are situated ........ /~......~.....~..~'.~.. ..................................................... 12 Does proposed construction wolate any zoning law, ordinance or regulation ...... .~......: ................................ 13. W~II la~ be regraded ..... ~....~ ......... W~II excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of prem,se~.~.~--~ ..... Address O,¢'~.~.....m~~ - ~- Name of Architect ....... .~. ............................. ............ Address ................................ Phone No ....................... Name of Contractor .....~..~.~.....~.~.. Address~/.~~..~Phone No. - ~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ex~sting or proposed, and md~cote all set-bock d~mens~ons from property lines. Give street and black number or descr:pt.on according to deed, and show street names and indicate whether interior or corner lot STATE OF NEW YORK, I. COUNTY OF .............................. ~'~"~ ..... ~.,,~4z~.....~.'/~./..-4j~...~.~.~.~E'.'.~ ......... ; ............. be,ng duly sworn, deposes and s~ys that he ,s the apphcan, (Name of individual s~gnmg contract) above named (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 f~l~ this application, that all statements contained ~n th~s application are true to the best of his knowledge and belief, thor the work will be performed m the manner set forth m the apphcat~on filed therewith Sworn to before me this ............... Notary Pubhc,,~~....~~~(~ounty ..~~ ..... ~~ ........ JUDITH T BO~EN (Signature of apphcant) No~o~ Pubhc, Stc~e of Ne~ York No 52-0344903 Suffo[( County~ Comm~s,on Expires March 30,