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Home My WebLink About6500-z FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT CI'HIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6500 Z Permission is hereby gronted to: .....~...e..o..~..~.~.t. ~.e.~ ............................................. ............ .s..~.t.~.o..~.a. .............................................. at premises located at ...,.~../..~.....~.;~.d-..~k~....~...L(~?.2) ................................................................... ................................................. ..S..o.~kq.Z...a. ......... ~.:.~., ......................................................................... pursuant to application dated .......................... .AM ..~.~.~...~..~..0.. ...... 19..~.,~., and approved by the Building Inspector. FORM NO. 1 TO~VN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. .... '. ....... ~proved .................. ~J ......... :~ ........ , 19..Z.~. Pemit No .... ~:.~...e:~...~ ....... ................. ...................................... (Buddm~ector) ~PPLICATION FOR BUILDIHG PER~IT Date .............. ~.~. .................... , ~ 9.~.~... 1 NSTR, UCTIONS a. Th~s apphcat~on must be completely filled ~n by typewriter or ~n ~nk and submitted ~n trlphcate to the Budding Inspector, w~ 3 sets of plans, accurate plot plan to scale. Fee according to schedule b. Pict plan showing location of lot and of buddings on premises, relat~onsMp to adjoining premises or pubhc streets or areas, a gwmg a detaded description of layout of property must be drawn on d~agram wMch ~s part of th~s apphcat~on c. The work covered by th~s apphcat~on may not be commenced before ~ssuance of Budding Permit. d. Upon approval of th~s apphcat~on, the Budding Inspector wdl ~ssue a Budding Permit to the apphcant. Such permit,shall be kept the premises avadable for inspection throughout the work. e. No budding shall be occupied or used m whole or ~n part for any purpose whatever untd a Certificate of Occupancy shall have b. granted by the Budding Inspector. APPLICATION IS HEREBY MADE to the Budding Department for the issuance of a Budding Permit pursuant to the Budding Zc Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances or Regulations, for the construct~or buddings, ad¢it~ons or alterations, or for removal or demohtlon, as hereto described The apphcant agrees to comply w~th all apphcable la,. ordinances, budding code, housing code, and regulations, and to admit authorized ~nspectors on premises and m buddtngs for necessary mspect~o~ (S~gnature of apphca~or ame, ~f a corporation) (Address of apphcant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build ................................................................................ ...................................................................................... Name of owner of premises ............. ~....~...~. ....... ~.. ...... ~....(.~.....,'~.~:~, .............................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's L~cense No .......................................................... Plumber's L~cense No ......................................................... Electrician's License No ..................................................... Other Trade's License No ................................................... 1. Locationof landon whichpr~oposedw.,o~kd;ill~.ec~done. M~.,p4N,.~ ............. ~%~'¢~'" 7'~ ......... Lot No....~.'.. Street and Number ........ ~.~'. ....... ..~...'...:.~'...~..., ........ ~ ................................. i..~ .................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Ex,sting use and occupancy ............... ~..d....r~.~--,,....~....~.~..~'~.../...~..~.-:.....~........~(..~?./.X~..~. .................................... b. Intended use and occupancy 3. Nature of work (check which applicable): New Building V// Addition Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... (Description) 4. Estimated Cost ............ ..~'.....~...~.~..D..:....°2~.. ............ Fee ....~....?....~.....~ ...................................................................... (to be prod on hhng th~s apphcat~on) 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 occuoancv, specify nature and extent of each type of use ~...~ '.~-/~-~.~.~.(2...~.tz('~..~.~ 7. Dimensions of existing structures, if any: Front ........ ./...%2~.. Q .... Rear ..... ~'..~.~.. ............ Depth ....~....~. .......................... Heighl ............................ -~.~..f. ..................... 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 ....... .?~....O. .............. Depth .....-~....~ ................... Height ........................... .~...~..../. ............. Number of Stories .............. .~'.. ...................................................................... 9. S~ze of lot: Front ..........~?.~'...~ ..... Rear .......................................... Depth ................................................. 10. Date of Purchase .............. ~.~..~....~. ......... Name of Former Owner ......... ..~..Z'..2~...~.. .................................................. 11. Zone or use district in which premises are situated ............ x4.J.~(...~.~../.~ .-Z~.~_~T_. ................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... Z~'...o. ............................................. 13. Will lot be regraded ....... /~t..O.. ................. Will excess fill be removed from premises: [ ] Yes /IX/] No 14. Name of Owner of premises ..... . .-Z~..F~..~.@....~..~....~...../~.t~..~(¢~ ................ :..,, ......................................................... ..... 7'- (Address) ~~Z.~. (Phone No.) Name of Architect ..........t~j..~.~X~._t~./~ ..... .)~...-~2~P~ .............................. ~ ................................... (Address) (Phone No.) Name of Contractor ........ ..~....~.../(.../3('..(..C~....~..~...~..~..?. .................................. ..~....~...o..~. ~...~.)!7. ......................................... {Address) (Phone No ) Locate clearly and distinctly property lines. Give street and block er interior .or corner lot. PLOT DIAGRAM all buildings, whether existing or proposed, and indicate all set-back dimensions fro number or description according to deed, and show street names and indicate whet STATE OF NFW YORK, COUNTY OF ........... $1.lJ~ J~O .]...k ...... SS ) ~lO,..(~ o. ]~.t;~..17h(~ ....................... being duly sworn, deposes and says that he ~s the apphcant above nam~ (Name oJ mdt~tdual st~mg contract) He Is the .......... 0~.~ ........................................ (Contractor, agent, corporate o/freer, etc') .......... of sa~d owner or owners, and ~s duly authorized to ~rform or have performed the sa~d work and to make and hie th~s apphcat~on; that statements contained m th~s apphcat~on are true to the Ee[t.q~ ~A~owledge and behef; and that the work wdl be performed m the man set forth m the apphcatlon flied therewith (