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Home My WebLink About6492-z FORM NO. 2 TC~VN OF SOUTHOLD BUILDllqG DEPARTMENT TOWlq CLERK'S OFFICE SOUTHOLD, lq. Y. BUILDING PERMIT CrHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6492 Z Date ....................... A.]p ~t.3, ..... ~9 ........... ' 19'93" Permission is hereby granted to: ..~.~...~...~y. ................................................ ........... ~.~.,e...~.~ ................................................... ......................... ]~a.~ t; ltue~ ~ ............................... to ...~.e. ~.....a~..~....e~...~tt~;Ll~. ,Cent a ..... C.. at oe~a~ e.. &..w.$z~.. ~de.. ~'ea~-.- &.. ~Z-Ol~t" at premises located at ..~..~... ,~....]f.~..~; ................................................................................................. ................................................................. ~4~¢-ti~-~ ......................................................................... pursuant to application dated .................... Apl~..~ .......... $~ .......... 1~ ...... and approved by the Building inspector. Fee ~..~.~.T. ............. ....... .............. I Examined ....... Approved ........................................ , FOBM NO. I ~ TOWN OF SOUTHOL, BUILDING DEPARTMENT TOWN 4:LERK'S OFFICE SOUTHOLD, N. Y. Application No. ~' c~- ~__ Disopproved o/c ........................................................................................... APPLICATION FOR BUILDING PERMIT Date Apz':[l 19 ... 19..?..~ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurete 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 or areas giving a detailed description of layout of properW must be drawn on diagram which is part of this application. c. The work covered by this application mey not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit .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 Ce.rtificate of Occupancy 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 the Building Zone Ordinance of the Town of Southold, Suffo[k County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to co~l app cab e awe. ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buddings for neca~'s~ inspections. (Signature of applicant, or name, ifa corpora~e~j.,~ ........... ........... ............ .... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. 0tmez, Arthu~ Pe Name of owner of premises ....................... ~ ................................................................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................................................... Plumber's License No ......................................................... Electrician's License No ..................................................... Other Trade's License No ................................................... 1. Location of land on which proposed work will be done. Map No ............ ~ ............................ Lot No.....Z~.. .................. Street and Number ......... ~.~.~.....~'J,~l~...8.~ ........... J~i.l;.~l~ZC:'k .............................. ". ................................................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ........ .~...1~....];..].....:~..~ ......................................................................................................... b. Intended use and occupancy ............. .S.~....~.~..~.~...~.91'...~g~g~....(,~.~g.~,~l~l. eL.~;..~=l~). .............................. 3. Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration....~:.2...qf2~...~ Repair ......................... Removal ......................... Demolition ........................ Other Work ...-R.e]lce ...................... (Description) 4. Estimated Cost ............................................... Fee ..... .1..~..... ~ ................................................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ..~. .............. Number of dwelling units on each floor ............... ;;; ....................... If garage, number of cars ............................................................................................................................................ 6. If business, commercial or mixed occuoencv, specify nature and extent of each type of usa ..................................... 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 ................... ,.....:. ........ ;..f.. Number of Stories ........................................ 8. Dimensions of entire new construction: Front ......................... Rear ............................ Depth ................................. Height ................................................. Number of Stories ................................................... 9. Size of lot: Front ....~5=,~...,., .................... Rear ........ .8..~..~. ........................ Depth ....~,~'~.~....~...~,,~c~ ........... 10. Date of Purchase ..................................... Name of Former Owner ............................................................................ 1 1. , Zone or usa district in which premises are situat~l .................................. ]~...:1 ............................................................ 12. * Does prop0sad construction violate any zoning law, ordinance or regulation: ......... ~ .............................................. 13. Will lot be re<Faded ~ ............................ Will excess fill be removed from premises: [ ] Yes [ ] No 14. Name of Owner of premises ....~a-:l~ll3c'..~el~. ...................................................................................................... (Address) (Phone No.) Name of Architect ..................................................................................................................................................... (Address) (Phone No.) Name of Contractor .......... {~m .................................................................... ; ........................................................... (Address) (Phone No.I PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all sat-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate wheth- er interior or corner lot. STATE OF NEW YORK, ) COUNTY OF ............. I~..~..q~ ..................... ) SS .............................. .~....~...h.l~.......?.e.~ ..................... ' ...................... being duly sworn, deposes and says that he is the applicant above named. [Name of individual signing contract) -" Ovner - builder He is the ................................................................................................................................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that ell statements contained in this application are true to the best of his knowledge and belief; and that the_jffilfJ~ll~L~ performed in the manner set forth in the application fi ed therew th /E.qRI LEE Et. AK . ~ .~ __ ~ l~ffi.~t ~JSLtC. State ~! f,e~l ~0~ ~ '~ No. 52-61687-~ , ............................ *~.....day of ........... ~L~L~.......a~e~.,w.~u,,ol~)~.j~Y ...... / I ~ "~ otarY I' u bli c, ·..~:~............~. ~ ~ .......... County .... ~~.. ;? ~ : (,S¥&rmzmre of applicant}