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Home My WebLink About6934-z FOR~[ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ~ PERMIT (THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 6934 Z Date ............... Oe~ ......... J9.--.I ............... 19~3~... Permission is hereby granted to: ~ W;i,~..~T...~.~a~:t.e.~t ...... .Tennan~ ........ ~.A.~Ice Co 0~mer to erect ,.q~l ~aintain gro.:.tV3d si¢~ ...3.~..~...;~..3£t~ ....... ~/1.~h..~.2.t...s.~t;bsCk..& t+ft ..... ?.~.e...a.~.a.,.n.~.~ ..... .-....~;~.9...ag....a....~.o.....b..9..t.~..q~....o.~...s..~..~. ................................................................. at premises located at ..... ~..O...~.,.3.._..~.§.F.,..e...~...~!.~..~..~.....R.~ ......................................................................... ............................................................ ~;.~.it,~,~ .............................................................................. pursuant to applid~3tion dated ......................... g<J.t, ...... -1~- .... 19..~.].., and approved by the Building Insp,ector. ',~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ...L.!...~.. ............... l .......... , 19.~.~.... Approved ...........t.? ............. !.! ........... , 19.25 Permit No..~-?...Z'......~....'.~...~ APPLIC^Ti PER**,T Date ........ ~..../...Z .............. , 19.~.... INSTRUCTIONS o Th~s opphcat~on must be completely filled ~n by typewriter or ~n mk and submitted in triplicate to the Buildin inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule b Plol plan showing location of tot and of buildings on premises, relationship to adjoining premises or public streets, areas, and g~ving a detailed description of layout ofproperty must be drown on the diagram which ,s part of this apphcatior c. The work covered by th~s apphcation may not be commenced before issuance of Building Permit. d Upon approval of th~s apphcat~on, the Building Inspector w~ll ~ssue a Building Permit to the apphcant. Such perm 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 o Certificate of Occupant shall have been granted by the Building Inspector APPLICATION IS HEREBY MADE to the Building Department for the ~ssuance of a Bu,ldmg Permit pursuant to th Bu,ld~ng Zone Ordinance of the Town of Southold, Suffolk County, New York, and other opphcable Laws, Ordinances L Regulations, for the construction of bu~Idings, additions or alterations, or for removal or demolition, as herein describe, The applicant agrees to comply w~th all applicable laws, ordinances, building code, hous~n.c[ code, and regulations~l~ admit authorized inspectors on premises and in buildings for necessary inspections. ~~/' (Signature ¢1: applicant, or name, if a corporation! ..... .......... .... (Address of applicant) State whether opphcont ~s owner,~ agent, architect, engineer, general contractor, electr:c~on, plumber or bu~lde Name of owner of premises ~--~ ..~...' ~/¢'-'~ ;~ //'~'J~---- . ..................................... If apphcant :s a corporate, s~gnature of duly authorized off,cer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1. Locohon of land on which proposed work w~ll be done Map No .................................... Lot No ....................... Street and Number .... ~--D¢.C...~....~.. ...... ~.6t¢.,¢,/~...)~...~..: ..................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: /1/ a. Ex,siting use and occupancy ............ ..~.~.'~..~..¢.... ~.~-¢~..~ ............................. b. Intended use and occuponc¥ ..................... .~..~. , 3 Nature of work (check which applicable): New Budding ................. Addition .............. Alteration .... Repair .................. Removal .................. Demolition ................. Other Work ......... ~.C~~'2 ........................ (Description) 4. Estimated Cost .... ~.:......~. ...........................Fee ..~.....~ ............................................. (to be paid on filing this apphcation) 5. If dwelling, number of dwelling units..... ........... C~' .... ..... ...... Number of dwelhng umts on each floor ........... If garage, number of cars ......................................................................................................................... 6 If business, commercial or mixed 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,sa~s~rructurewithalterat,orA%or~add,tions: Front ......... ~i ....... Rear. Depth ........ ~ ............ He,ght ......~ ....... Number of Stories ...... i..._...? .............. // 8 Dimensions Cf ent,re ne~v construction' Front ............. .~../. .............. Rear ..... ..'~... .................. Depth ...~.. Height ....... ~...~. ....... Number of Stories ...................................................................... 9 Size of lot' Front .............................................. Rear ....................................... Depth... 10. Date of Purchase .................................................. Nome of Former Owner ..................................... 11 Zone or use distr~ct in which premises are s~tuated ................................................................................. 12 Does proposed construction violate any zoning law, ordinance or regulation. 13 W~II lot be regraded ............................ Will excess fill be removed from premises' ( ) Yes ( ) No 14 Name of Owner of premises ................................................ Address ................................ Phone No ..................... 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 red,cate oil set-back dimensions fror~ property lines. G~ve street and block number or descnpt~on according to deed, and show street names and indicat.- whether interior or corner lot COUNTY f'~F/...,~.~...~..~......^~v . ..... - (Name of ind~wdual s~gmng~racf) above named. .................................. .................. .......................................................................... (Contractor, agent, corporate officer, etc ) of said owner or owners, and th~s apphcat~on, that all statements contained in th~s application are true to the best of his knowledge and belief, that the work w~ll be performed m the manner set forth m the application filed therewith. Sworn to me th~s 4 fof , ..................... Nota~ Pubhc { ~ .... ~unty ...................... JUDITH T BOKEN ~~S~t~e of apph~nt) Notary Pubhc, No 52-O3449-'~ Cuffoik Cc)unly/l ~ (