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Home My WebLink About6370-z FOI~M NO. 2 TOWN OF $OUTNOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6370 Z Permission is hereby granted to: Tuouis & Caz'mel~ ~ ............ ~.?L...!:~..z...%!:~,,,~.....s..q. ................... Nelvi!!e N.Y. to..~e.?.~%~2~.~.~..~.~.~.a.~`~.h~.~...~.~.~..~.~.~.~L.~.~..~.~.~.~.~.~..~ .................... at premises located at ...~.../..~...,,~.,0..~..~...o..13.....~..~...~..e. ...................................................................................... 8au%hold ~ pursuant to application dated ...................... ?.,.e,.~,, ......... ~ ..........L, 19..,~,~,, and approved by the Building Inspector. Fee sJ.~i....o..o.. ........... Building Inspect~ APPUCATION FOR BUILDING PERMIT '-. ~. .......... ................ INSTRUCTIONS a. This application 'must be completely filled in by typewriter or in ink and submitted in triplicate 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 premises or public streets or areas, giving a detailed description of layout of property must be drawn on diagram which is pert of this application. c. The work covered by this application may 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,shaft be kept o1~ 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 Certificate of Occolxlncy ~hall have beel~ 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, Suffolk County, New York, and other applicable Law~, Ordinances or Regulations, for the construction building, additions or alterations, o~ for removal' or demolition, as herein described. The applicant agrees to comply with Mt ordinances, building code, h~using code, and regulations, and to admit authorized inspectors on premises and in buildin~ for nece~aW in~oectlon$. Builder's License No .......................................................... Plumber's License No ......................... ~ ............................... Electrician's License No ..................................................... (Address of app icant) ~ ~./~f. State whether, ,applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................................................... ...... --. .......... : ............ ................... ........ .................................. ,... Name of owner of premises ..,/~.....~..~.,~.....~....'~%..~....~,.Y~,.......~..:.(~.A~ .~...~.~,~.~.......~.~..'~4..~..1:t~.~ .............. If applicant'is a corporate, signature of duly a~thorized officer. ~ IName and title of corporate officer) Other Trade's License No ................. ;. ................................ 1. Location of land on which proposed work will be done.,~Map No......~......~.. ........... ~.~...., ........... ;Lot No...,,.,L ................... St reet and Number ....~'~.~.~ :..v~....~'::~.~! ......... ~..% ~..~./~. ................................................. :.....: ............. '' "~- -- Munictpal,ty - 2. State existing use and occupancy of premises and intended use and occupancy of propoaed construction: Existing use and occupancy .................................................................................................................................... Intended use and occupancy .............. ~.;~!~a .................................... i ................... ',~ i ae Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration ............... Repair ............. Removal ............... Demolition Other Work ,~...~ ..YI...~..~...../~.~'(~.~ (~ription 4, ~tima~d Co~ ............................................... ~* ........................................................................................ {to ~ ~id on filin~ thi* a~lie~tion} $. If d~llin~, numar of d~llin~ unit~ ................. ~um~r of dw~llin~ uni~ on ~ech floor ......................................... If ~r~, numar of ~ ........................................... ~. ~ '~f.bu~in~, eom~mi~l or mix~ o~u~n~, ~oif~ n~tum ~nd ~xt~nt of ~h W~ of u~ ..................................... 7. ~im~n*iom of exi~tin~ ~ru*tur~, if ~n~: ~ront ..................... ~*~r ........................... ~*~th ................................... ~iflht ............................ .... ..... ........ : .... ..... ~um~r ~f ~ori~ ...................... -~ .................................................... Dimon~iom of mm~ ~truetur~ with ~lt~ratiom or ~ddifion~: Front .......................... ~,~r ......................................... D~th .......................... .............. .....~i~ht .~'.~..~ .............................. ~um~r of $torie~ ................................... . .... 8. Dim~mion~ of ~ntim n~w con,ruction: ~ront ......................... ~ar ............................ ~pth ................................. ~i~ht........ ............................ .. . . .. ...... . ~um~r of 8torie~ ......................................................................................... O. 8iz~ of ~ot: Front ......... ~....~ .................... ~r ................................... ~... ~th 10. ~ of ~u~h, ........ ~*~o, ~orm~r Own~r...~..~. ....... ~..~.r.~ .................... 11. Z~ or u~ diarist in whioh ~r~mi~, am ~i~d ..................................................................................................... 12. ~ ~rop~d ~n~otion viOl~m ~n~ ~onin~ I~w, ordin~ne~ or r~lation: ............................................................ 1~. ~ill lot ~ m~d ....................... : ....... ~ill ~x~ fill ~ mmo~ frqm ~m~i~: [[ Y** _ [ ~o ~4. mm~ of O~,r o* ~m~ .~....~.. .~.~..~..-..~L- ~"~'J~ .... Name of Archi~t ............................................................................................................................................... ~ ~.-~ (Addre~) (Phone No~ N~e of ~ntra~or ........................................................................................................................................ ~.., ...... (P rune No.) PLOT DIAGRAM L~ c~rly and di~i~tty ~ ~ildin~, ~h~ exi~ir a~ indica~ all ~t~a k dimen~ one from ~.~,~_~ pro~er int~i~li~'GiVeor corner ~m~lot. and bilk Jm~r or de~iption ~ording to and show_ ~mettflt[.&~nam~ nd indi~ /~- ~ " STATE OF NEW YORK,~ ~1¢ ) -- COU,TV. ~_ ~ ~xOF ................ ~.~.[....L~...~......~ ~ , ' ........ .~..~.~ ....... ~,~.~.~.~:~ ............. being duly sworn, de~ses and says that he is the applicant above named. IN'me of i~divid~ si~ing con~act/ He is the ................................................................................................................................................................................................................. { Cont~ctor, agar, co~te o~r. etc.} of said owner or owners, and is duly authorized to ~r~orm or hays ~rformad the said work and to mats and file this a~OHcation; statements ~ntainad in this application ara true to t~ ~st of his knowled~ and ~liaf; and that ~ha work will ~ ~dor~ ~t forth in t~ aO~i~tion filed t~rawith. 0 ~ ~_ ~ ~ .~ eUBLLG State ~ ~ ~ ............... ~ ............... d~v of ~... :..:...: ....... ~.. :~:. - _.~ .~.: ..... ~ / ~ Notary Public, .~....~~ ~unW ...... ~~.~.....:.~;~:~?:.; ..........................