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Home My WebLink About6456-z FOI~i~I 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) N? 6456 Permission is hereby granted to: · .~..~ r~z.~...~,~. ....................................... ................ .......................................... to .... e,~e~ f.. and.. ma ~.ta ~n.. ~ct~.. &.. r~ ar...ya~ct... £enma.....~.t.. ~L.~h. ............................ at premises located at . .~../~...~.~..~..~...]...~....~.,~.,,a:.,~.......(~.~..~..~..) ....... ; ............................................... g.~.t~l~.~.g:~e ... J~'~ J~ : 19..~.~.., and approved by the pursuant to application dated ...... ~., ................... , Building Inspector. i~ Fee $...15 ~,.0,0 .......... Approved ........................................ TOWN OF SOUTHOLD BUILDING DEPARTMENT ~ TOWN' CLERK'S OFFICE Disapproved a/c ~ .............. ~ (Building Inspecto~. ; APPLICATION FOR BUILDING PERMIT INSTRUCTIONS ~,' th~ a. This application must be competely filled in by typewriter or in ink and ~ubmltted in triplicate to the Building Inspector, wi 3 sets of plans, accurate plot plan to scale. Fee accord[n§ to schedule. b. Plot plan showing location of lot and of bui}dings on premis0s, relationshi~ to adioining promises or public streets or areas, and~ giving a detailed description of layout o'f property must be drawn on diagram which is part of this application. c. The work covered by this applicati6n may not be commenced before issuance 9f Building Permit. d. Upon approval of this application, the Building inspector will issue a Building Permit to the applicant. Such permit,shall be kept on ;the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose wJ~atever until a Certificate of Occupancy shall have b granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the Issuanqe of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffoik 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 all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspect;ors on premises and in buildings for necessary inspections. · V Bernze S al ey (Signature of applicant, or name, if a corporation) ................... [~..J:. ~ .a..~,E,..~-~:o..9~ ~ ....... Cut oho g.u...e.... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, genbral contractor, electrician, plumber or builder. .................................................... ..................................................... ; .......................................................................... Name of owner of premises ........ .,~..e...~..~,~,e,...G,',,~,~..~..M.e,~ ..................................................................................................... If applicant is a corporate, signature of duly authorized officer, f ~ ~Name and title of corporate officer) Builder's License No .......................................................... Plumber's License No ......................................................... Electrician's License No ..................................................... Other Trade's License No ................................................... 1. Location of land on which proposed work will be done. Map No .............. ~ ........................... Lot No....~.. ................... Street and Number ........ ..~./.~...~.~..~..~.e....~..o.D.,.~ ......... ,~.~.¢.~.O.g.~.~.....l,..~.,.~.~ ............................................................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... ~.~.~.,~,~,~A ...... '.. · b. Intended use and occupancy .......... ~..~..~..e....W~.~,~...~,ffr~.~..~,~,~.q]..i;~.~.~,~.~ .......................................................... % Na.'ure of work (check which applicable): New Building ....................... Addition ..................... Alteration..........:. .... Repair ......................... Removal ......................... Demolition ........................ Other Work ......~..e..n..9..e. .................... (Description) 4. L:stimated Cost ............................................... Fee ....... .1..~.,...0..0. .............................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ..... .o.. ......... Number of dwelling units on each floor ......................................... If garage, number of cars ............................................................................................................................................ 6. If business, commercial or mixed occupancy, 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. Dimensions of entire new construction: Front ......................... Rear ............................ Depth ................................. Height ................................................. Number of Stories ......................................................................................... 9. Size of lot: Front .........~.~0...'1: .................. Rear ............. ~i.~.Q...~+ ................. Depth .................................................. 10. Date of Purchase ..................................... Name of Former Owner ............................................................................ 11. Zone or use district in which premises are situated .......... Ag.~..~.c.....-...?~?..s......!~..A.~.~....~..~.s..~. ......................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .................. no ..................................... 13. Will lot be regraded .... 1~ ........................... Will excess fill be removed from premises: [ ] Yes [ ] No 14. Name of Owner of premises ...... ~erJ0.;tg...lSJ0.~,2.V..~r. .............................. ~.~F~ ............................................ (Address) (Phone No.) Name of Architect ..................................................................................................................................................... (Address) (Phone No.) Name of Contractor .......... .s..a....m..e. ................................................................................................................................ (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 ................... ,~, .?:.~ :~ ?. ,'~., ,~. ................ ) Bernard Shalvey .......................................................................................................... being duly sworn, deposes and says that he is the applicant above named. (Name of individual signing contract) Owner- builder He is the ........... . ....................... (Contractor, agent, corporate officer, 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 forth in the application filed therewith. .............................. .~.....day of ................... ..~.~.?...~...~. ................. 19 ............. ]~ ]r)~ ~ Notary Public ...................................................................... County --¢~' -- '~' '~' ' '~' '~' "?' '¢/' - ' ';~'~' ' ' ' '~' '~'~:' 1 .............................................. ) ('Si[inatureof apt~ican t)