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Home My WebLink About6968-z FORM NO. 2 TO~N OF $O~THOLD 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? 6968 Z Permission is hereby granted to: ~..~.r..:~.ck~ ................................................... ...... :Ee exm-¢c .. ~.~ .. ~.~4 ................................. ............. i~t~£t-~ ..... .(/~___~_~eX) .................. ~o .... ~ .e..e..~....a..a. ~...~ ..~...~p....~..~.¢~. .......................................................................................... ,qt premises located at 'P~'eC~_.~"~t~"'~VC["'--'l~1~D--~-~tt'~?~L~a~a:~- .................................... .......................................... ~t.~i~.~ck ..... C~a~re!.. ~i s.t...1 .l,) ....... .[~ .,~, .................................... pursucnt to cpplication doted .......................D~ ...... ~. ............. , ]gr~..~ ..... end ~pproved by the Building Inspector. FOII~I NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. NOTICE OF DISAPPROVAL Fde No ................................................................ Date .......................................... , ...... ............ PLEASE TAKE NOTICE that your application dated .................................... , 19 .... fo~ ~...~nstruct ..... ~ .............................. at the prem,ses located at ....?/...c..~....r~..~.~r.~ .............................................................. Street Map ... ~ Block ~/'x Lot ~ ~s returned herewith and disapproved on the following grounds ..¢..~ "~........~.~& ..... ..-...,..,~.o....~~ ..... ~ .......... ~...:.-~..~..~.,~_ ~' ~ L,, ~'~ ~:~ J,~ c~_ ~ TOWN OF SOUTHOLD ~'~ ~' 'lV~ "~ ~ BUILDING DEPARTMENT ~,~t j,~ ~¢ ~ ,~t0 TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ......... ~...~... .......... 1 9.~..~ / ...~....~//? Approved ................... '..~. ..... ~ ........ , 191~..~i Pemit No .................... ....~.... .... Disapproved O/C Application No .............................. APPLICATION FOR BUILDING PERMIT Date .... , . ................. , 19. INSTRUCTIONS a. This apphcat~on must be completely filled in by typewriter or in ~nk and submitted ~n triplicate to the Budding Inspector, w 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot p~an showing location of lot and of buddings on premises, relattonshtp to adjoining premises or pubhc streets or areas, , gwing a detluled description of layout of property must be drawn on diagram which is part of th~s apphcat~on c. The wurk covered by this apphcatlon may not be commenced before issuance of Budding Permit d, Upon approval of this apphcat~on, the Building Inspector wdl issue a Building Permit to the apphcant Such permit,shall be kept the premises avadable for mspectmn throughout the work. e. No building shall be occupied or used m whole or m part for any purpose whatever untd a Certificate of Occupancy shall have b granted by the Budding Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Budding Permit pursuant to the Building Z. Ordinance et the Town of Southold, Suffotk County, New York, and other applicable Laws, Ordinances or Regulations, for the construct~o buildings, additions or alterations, or for removal or demolmon, as herren described The applicant agrees to comply with all apphcable la ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and m buildings for necessary mspectm . ........................ (,9)'gnature of apphca~, or name, ~ a corporation) ......... ............ d' p ) ,..-.~ State whetlher applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bull: Name o, owner of premises .......... ..~.'~.P~.'.V~........~.:......~.~..~.~.~..~.~. ................................................................... If applicanl is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................................................... Plumber's License No ......................................................... Electrician's Lmense No ..................................................... Other Trade's License No ................................................... 1. Location of land on which proposed work will be done. Map No ............................................... Lot No.~../.:..~. '~..:./.,. Street and Number ...... .~.~?.~../..~.....~.~;~¢....~/.-'..~.~;.~../~. ..... .././.~.~-,~£~,;.~.~£;/z~.... ...... 'l~l'~'~i~;~ii~ ........ 2.State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ......... ~..~...~..~. ............ :,.~ .................................................................................... use and occupancy .................. ~. ..... :...(...~../..~..~...=.....~; ..................................................................... b. h itended / /' 3.~ N~ure of work (check which applicable): New Build,n§ ....................... Addition .......,/... .......... Alteration ....... Repair ......................... Removal ......................... Demolition ........................ Other Work .... ~.~..J~..~-~.. ............. (Description) l/ 4. Estimated Cost .......,~..~.. ~)..~.~) .......................... Fee .............. .,,,,~,,-~-,.,,,~,..~-.~, ........................................................... (to be pa~d on hhng th~s appheat~on) 5. If dwelling, number of dwelling units .................Number of dwelling units on each floor ......................................... If garage, number of cars ............................................................................................................................................ §. 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 same structure with alterations or additions: Front .......................... Rear ......................................... Depth ............................................. Height ......................................... Number of Stories ........................................ 8. Dimensions of entire new construction: Front ......................... Rear ............................ Depth ................................ Height ................................................. Number of Stories ...................................................................... 9. Size of lot: Front ........ ?..~...Q. ..................... Rear ......... /...~....~. ....................... Depth ...... ~..~..~.2.. ............................. 10. Date of Purchase ..................................... Name of Former Owner ................................................ .o .................... 11. Zone or use distr,ct in which premises are situated ........... ~..~.,~J..~.~.j. ........ ~..~.~.~2.C~,O.J ....... ..~.'.').~i..~ ............. 12. Does proposed construction violate any zoning law, ordinance or regulation: .......................................................... 13. Will lot be regraded ...............,'m...~ .......... Wil_J. excessqfill be removed from prerp4ses: [ 1. Y, es. [ ] No__ 14. Name of Owner of premises ..... ./~'..~.?...g....k:7:......./.: ...... .~.O..~.i2..].I..~_..../~.~....~.G..~..~,./.~.....~..:~./.~ (Address) ! (Phone No.) Name of Architect .................................................................................................................................................. (Address) (Phone No.) Name of Contractor ...............(~.J.L~....t~.'..~...________________~.. ........................... ~ .................................................................. tAddress) (Phone No.) ........ PLOT DIAGRAM Locate clearly and d~stinctly all buildings, whether existing or proposed, and indmate all set-back dimensions fro property lines. Give street and block number or description according to deed, and show street names and indicate whet Z~O0 ~ -- er interior or corner lot. COUNTY OF . . /~O/f//--~t ........ ) .5;5'. ~'CO (-" '~ ~Tz_C/ ~lvL~ . .... ~~~~ ....... bemgduly sworn, de poses and says that h els the apphcant above nam He ~s the .............. ~~. . . (Contractor, ugent, corporate o[~ce~, etc ) of sa~d owm,r or owners, and ~s duly authorized to ~rform or have performed the sa~d work and to make and fde th~s apphcation; tha, statements contained m this apphcat~on are true to the best of his knowledge and behef, and that the work wdl be performed m the ma~ set forth ,n lhe~pphcat,on f,led there./. ~ ~CV~,tjS W,~l~gZ Notary Public, ./~.. ~~~ County .... /.~er~.E~?~..~::~.~.'..~.~ t_ ~ (S~ture of apphcant)