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Home My WebLink About6591-z FOR~ 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 COMPLETION OF THE WORK AUTHORIZED) 6591 Z Date ............................... I~I.~L~' ...... ~ ....., 19..~?.~. Permission is hereby granted to: Ed,~a~..Z~a.~b~ .................................................. ................. Oz'J.e,~,....]~,~ ................ .. ............. to ..~~....]~L~,i~ ..a~ ..a~dit J_c~ ..o t~ ..e x.t s.t ~.~g .. 2.a~lj~..~ t,~,n~ .................................. at premises located at .........S,/.~...~.3;~,~ ....... (.j.~.~t~h.~..'L.'J..~ .................................................. ~,~u~nt to ~ppfic~tion d~ed ............................... ~'~,~ ....... ~. ..... , 1~..~., ~nd a~pm~ by the Building Inspector. ......... TOWN OF SOUTHOLD BUILDING DEPARTMENT ? '~"~ ~ ,~ . TOWN CLERK'S OFFICE ~.~ SOUTHOL,, N.Y. ~/~ Exomined ....................... , 19..~ ~pplicoti~ No ............ ,: ................. ................. .......... ...... , ,¢.7} 67 ~i~pprov~ a/c ................................... :: ....... APPLICATION FOR BUILDING PERMIT .......... ........ . I ~$TRO~IO~S a. Thi~ ~¢~lie~tion mu~t ~ eompl~t~ fill~d in b~ ty~writ~r or in ink ~nd ~ubmitt~d in tri~licet~ to th~ 8uildin~ Im~etor. b. ~lot ~l~n ~ho~in~ Iocetion of lot ~nd 9f buildin~ on ~remi~, relation~hi~ to ad~oinin~ premim~ or ~ublie ~tre~t~ or area~, and ~i~in~ a d~t~il~d d~mriCtion of I~out of ~ro~rty mu~t ~ drewn on di~r*m which i~ pe~ of thi~ ~. The wo~ m~md b~ thi~ ~lie~tion m~ not ~ ~mm~n~d ~fore i~uan~ of 8uildin~ ~rmit. d. O~n ~ro~l of th~ ~¢icetion, the 8uildin~ In~tor ~ill issu~ ~ 8uildin~ ~rmit to th~ a~¢imnt. 8uoh ~rmit,*h~ll b~ k~t o~' the ~remi~, ~i1~ ~or ink.etlon throughout the ~Ork. ~. ~o ~ui~din~ *hell ~ ~u~i*d or u,ad in ~hol~ or in ~ for ~n~ ~ur~ wh~t~r until ~ ~ren~d b~ t~ ~u}ldin~ In*~or. 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~ Suffotk 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 comply with ell applicable laws, ordinances, buildir~ code, housing code, end reguletions, and to admit authorized inspectors on premises end in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is own. er, levee, agent, architect, engineer, general contractor, electrician, plumber or builder. · ...... ................................................................................................ Name of owner of premises ..~..'~ ....... ...~-~..(4-...~...~.../.. .................................................................. , .................. If applicant is a corporate, signature of duly authorized officer. Buildar°s License No .......................................................... Plumber's Licanse No ......................................................... ~lectri¢ian's License No ..................................................... O~har Trade's License No ................................................... ,. Location of land on which proposed work will be dona. Map No ............................................... Lot ~o ......................... Street a~d Number ...~'j.~,!..~.....~..O...~...~ ....... ,~:...~_.~...%.~ ............................... : ............ ,..,...., ............. Municipality 2.State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... "~..~....~7'~ ...... t~..~..~.....~ .............................................................................. b. I ntended use and occu pa ncy ..~¢~'...,/~ ../~,. J:...'-:~..L .....'..~...~.. ....... f~.....~....~...O:.~.....~...,~....~..~ ........ .~'......~......~...~ .... 3. Nature of work (check which applicable): New Building ....................... Addition ....~ ...... Alteration ............... Repair ................. Removal ......................... Demolition ......... ........ ~.. Other Work .................................... / ~) r _-------'-~ (Description) 4. ETate~o~st .......... '-~...~...:.....~'~... .......... }.ii}i...... FNejr~ .2}.~;t~ .~.l~t~.~;~!}}!!j. il .............. }'"i ..'i}i $.//~ dwelli/n~umber of dwelling units ......... 'g ' . ................ iiiiii" .. " If gara~,'number of cars ............................................................................................................................................ 6. If business, commercial or,mixed occuoanc¥, specify natur~ and extent of eacch type of use .............. .~, .................... 7. D~menslonsof ex~st~ng structures, if any: Front .....~..~......'..... Rear ......~....~.. .............. Depth .~(...?:'... ........................ Height .~.......'~..~ ............................................. Number of Stories ... .......................................................................... Dimensions of same structure with alterations oradditions: Front .......................... Rear ......................................... Depth ..... ~ .................. '~ He ght ; ~. Number,of Stories ......... , ...... y .., ......... 8. Dimensions of entitre new construction: Front ...~,~,~ ............. Rear ....~....~. ................ Depth ..~....2~.. ...................... ~.. Height ." ........ ~. .................................. Number of Stories ......................................................................................... 9. Size of lot: Front ...................................... Rear .......................................... Depth .................................................. 10. Date of Purchase ..................................... Name of Former Owner ............................................................................ ,.11. Zone or use district in which premises are situated .................................................. ~ .................................................. 12. Does pro¢0sed construction violate any zoning law, ordinance or regulation: ...,~..~. ................................................. 13. Will lot be regraded ~__ ~..~.-...--'--.u, ......... ~ e c)j~s fjJl~be remove~cJ from pre~.ajses: [ ] Yes _ [ ] Noj_., 14. Name of Owner of premises .-.~x~.. · .e. · -~.. · ..~1'. ......... ./..~..-..Tx~'x~ · .~../... · .......... .~'..~/.~,~...~.......~.....~... ~...~....(~2..~...;..~ .......... (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 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 ...~.~...~...~;..d..Z...~'.. ............................. ) ....... · .~.-..~...~...~...~'.~........~....".L/~L..~.~.~...~. ................................ being duly sworn, deposes and says that he is the applicant above named. (Name o£ individual signing contract) He is the ....... ~ ...................... ..~...~../~...-~._~.. ............................................................................................................................................................... (Contractor, agent, corporate of ITcer, 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 all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set f~orth in the .a0plication filed therewith. ......... ....