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Home My WebLink About6570-z FOILM NO, 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) N? 6570 Z Permission is hereby granted to: ....~..,.~.~Lc. ~..e.~ .......................................... ....... C~'-,~d...S.t ............................................... to...E.~.e..~.~.~t..~..~.~.t.~.;~.~.~.~.~.r.~3~fe~e..~.~.~t~a~d.~.~e~ ........... at premises located at ...... ~.~.~,...~..~1~!1~.~3,..5~ ........................................................................ ~lev pursuant to application dated ....................... ~ ..........~.~ ............ 19..~.~., and approved by the Building Inspector. Fee $...1.~.Q0 .......... Approved ........................................ i FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. DisopproYed o/c ............................................................................................ I NSTR,UCTIONS a. ThJs application must be completely fdled m by typewriter or Jn ink and submitted in trlphcate to the Building Inspector, wi 3 sets of plans, accurate plot plan to scale. Fee according to schedule, b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premJses or public streets or areas, a giving a detailed description of layout of property must be drawn on dmgram which ~s part of th~s apphcatlon. c. The work covered by th~s apphcat~on may not be commenced before issuance 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 occupmd or used m whole or In part for any purpose whatever until a Certificate of Occupancy shall have bc granted by the Braiding Inspector. APPLICA'I ION IS HEREBY MADE to the Budding Department for the issuance of a Bmqding Permit pursuant to the Bu~Jdln~' Zo Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances or Regulations, for the construction buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply wtth all apphcable law ordinances, budding code, housing code, and regulations, and to admit authorized inspectors on premises and m buddings for necessary ~nspectior (S~gnature of apphcant, or name, ff a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, epgineer, general contractor, electrician, plumber or buddE ................................................................................f..: ................ ........................................................... Name of owner of premises [.~Cs t,~A ~L.~./.t/.,~ /~.J~--~..~., C/~ .~../~Lm.,~'..~.~., if applicant is a corporate, signature of duly authorized officer. {Name and title of corporate officer) ~. . / Budder's License No .......................................................... /~ C ~,'., . Plumber's L~cense No ......................................................... ElecLric~an's License No ..................................................... Other Trade's License No ................................................... 1. Location of land on which proposed work will be done. Map Nq ............................................... Lot No ........................ Street and Number ........ 0..J.~..,C.,.,..~.~..~,.~.....~. ....... . .~J~.........~..,~..~..~.~.~..?.~ ...................... .,~..~..~.....,.~...!~!~?..(.~....(,~ ~_~ I C~ ~ Municipality 2. State existing use and occupancy of premises and intended use and occupancv of proposed construction: Existing use and °ccupancy '"~"~"(~'~'"'~"'~' ' '1~:' ' ' 'O'''' ' ' 'v~' ' '"~¢~4,^/r~'f'%.4-l/--A/i",~- ............. ~:'~'"': ......~" .......................................................... a. b. Intended use and occupancy .... ,~...../~.:..1 ...u~...... Y. Z.. !....:..LJ.....:.....~T...[.:..?.. ~. ........................................................... :~. ' Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work ....... ..'~E..~.:~)..~.~ ........... (Description) 4, Estimated Cost ............................................... Fee ...Lf_.. ...................................................................................... (to be pa~d on flhng 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 occuoancy, specify nature and extent of each type of use ..................................... 7. Dimensions of existing structures, if any: Front .....................Rear ........................... Depth ................................... Heighl ........................................................... 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 ...................................... Rear .......................................... Depth ............................................... 10. Date of Purchase .~'X'~,.-~.~.,..~.,~.-~-.~ ..... Name of Former Owner .... .~.....~(..'f~.....~. ..... ~v~xz'g~..'~,.. ................... 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 I~e removed from premises: [ ] Yes [ ] No 14. Name of Owner of premIses ~`~&~~¥~P~L~r~&%~Z~~2~¢~ (Address)t ,-- -- '" ¢ (Phone No.) Name of Architect ................................................................................... ~..H..[~.~...r."../7..~.~:~7:...~.!:~..~L~ ....................... (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, COUNTY OF ..... W~atgh~.s. ter ]3a~]~.~.~.g. E, ...C.~nq.el.1 ............. being duly sworn, deposes and says that~e is the applicant above nam: (Name of md~m dual s~ tn~ ~n trac~ ) ~e ~s the owner (Contractor, agent, co.orate officer, 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 apphcation; tha, statements contained m th~s apphcat~on are true to the best of h~s knowledge and behef, and that the work wdl be performed m the mar set forth in the apphcat~on filed therewith · . · ~ ~ . ........ day of ..... ).kC~ ............... 19 Z 3 Notaw Pubh~4 /', 4:~~aryL~"~3~/:~:~;w Yor~ ~ .~.t ~ .............. / ~om~ed ~o: .e c ' ~, ~ount¢ ..... (S~ature ofapphcant) '