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Home My WebLink About6520-z FOEM NO. 2 TO~VN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT J (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6520 Z Permission is hereby granted to: ........... ~a.t ~.~ok. ........................................ ~o ..~.~ ~p..~.....~..~ ~.t..a..~.n....~..t... ~ ~.~.~....q~.~.n....~..~....r. ~.c..~ ................................................. at p~emises located at ................ ~eIt'~&~...l~e&(J' ............................................................................ ........................................................... ~l;t~i<~ ........ N-.-¥.~ ............................................................... pursuant to application d~ted ..........................A]p~i,l.....~6. ....... , ]9~ .... and approved by the Building Inspector. Fee $.1.5~.(~ ............ Approved ................. ".! ........ :..(. ......... , Fo]a~l NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 19.76 I~.Z.,~.. Pemit No .... .~.....~'...,~....O....~ ....... Disapproved a/c ............................................................................................ Application No....,~...,~.,.~ .......... r INSTRUCTIONS a. Th~s apphcat~on must be completely filled in by typewriter or in ink and submitted in trlphcate to the Braiding Inspector, w 3 sets of plans, accurate plot plan to scale Fee accordmg to schedule. b. Pict plan showing location of lot and of buildings on premises, relatmnsMp to adlo~mng premises or pubhc streets or areas, · g~wng a detmled description of layout of property must be drawn on diagram whmh ~s part of th~s apphcet~on. c. The work covered by th~s apphcatton may not be commenced before ~ssuance of Budding Permit. d. Upon approval of th~s apphcat~on, the Budding Inspector wdl issue a Budding Permit to the apphcant Such permit,shall be kept the premises avadable for inspection throughout the work. e. No budding shall be occupmd 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 Budding Department for the ~ssuance of a Budding Permit pursuant to the Building Z, Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances or Regulations, for the construct~o[ buildings, additions or alterations, or for removal or demohtlon, as herein described The apphcant agrees to comply w~th ali applicable la ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspectJo (S~gnature of apphcant, or name, ff a corporation) (Address of applicant) Sta~e whethe~tapplicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build .. ~. ~- .':'1,,¢,,,,.~,.,f'/' ................................................................. 'J' ....................................................................................................... t~ Name of owner of premises ...... ~',~=..t ............... t.~ ............... J.~.~...~--~...F~..~..~.~..-~. ................................................ If ap~,is a corpo~ignatu~u__~ ~IY au thorized o ffi~er. .... ....... ....... lName a~d title of~cor~ o~mer) Builder's License No .......................................................... Plumber's License No ......................................................... Electrician's L~cense No ..................................................... Other Trade's License No .................................................. , , _~ "' ~~,,~4 1. Location of land on which propomd work wiU~e done. Map No ........ ..... ...~_~ ................. Lot No ........................ treet and Numoer ............ ~~~_..~.~, ......................... 7 .......... ~ .............................................. Municipality 2. State existing use and occupancy of premises and intended use~d occupancy of proposed construction: a. Existing use and occupancy ....... ~ __ ............................................................. b. Intended use and occupancy ............................. ~ .............................. ~ ....................................................... 3. Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work '~1 'D~'~n~ .......... 4. Estimated Cost ...... ;~...~...~ ................ Fee ........................... ~ ..................................................................... (to be pa~d 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 ..................................... 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. D,mensions of entire new construction: Front ......................... Rear ............................ Depth ................................ Height ....................................... ~ ......Number of Stories ..... ._. ................................................................................. 9. Size of lot: Front ......... .~.~...~.. ................ Rear ........ ___,-~./~..~,...~.. .................... gepth~..~.~....~....Z.2}....~-~,~.._--~, __ ,--, ............. 10. Date of Purchase ..................................... Name of Former Owner ........................................................................... 11. Zone or use district in which premises are situated .................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .......................................................... 13. Will 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 existing or proposed, and indicate all set-back dimensions fro property lines. Give street and block number or description according to deed, and show street names and indicate whet er interior or corner lot. STATE OF NEW YORK,' //. , ~/ ) SS ..... · ~ ........ bmng duly sworn, deposes and says that he ~s the apphcant above nam~ ame o£ ~ vt~ua/ ~ ng~con ' ct) He ,s the ........ .C~. C .~..~. ~.'.'~~ ..... t. ....................................................................... (Contractor, agent, corporate officer, of smd owner or owners, and ~s duly authorized to perfor~ OrTha~K~)~,lr. formed the sa~d work and to make and fde th~s application; tha, statements contained ~n th{s apphcatmn are true tothe bJ~l~,;~ J~i.~Bl~no~|edo¢.~nd be el, and that the work wdl be performed m the mar set mrrn ~n the app cat on hied therewith I~o 52-03449C. 3 Suf.%lk ....... ~.(.~_,,-.-davof;;7... ~..,,) ........ 19 ./.Z~.. (Si~ature of apphcantJ