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Home My WebLink About6460-z FORM NO. 2 TOWH OF 5OOTHOLO 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) Ne 6460 Z Permission is hereby granted to: ................. ~.¢a~t~ itn~k ........................... ............. rD ...~r.e.¢*~...~..m~,%n.t;*%:Ll..f~c~n~..~.~.c~.*.f. enc. L...(3£.~k ~,gk.~.9~,.~..~...~.~**3,) ........... at premises located at .~..~..~..~fL..~..~j.~R~3~.~.~....~.~.~..~.~..~.~...~..~.~L...~..~..~.~.0.~* ................. ...................................... .~.~.. ~h~ r.e .. ]~o~ ........... ~outho ~L, ..................................................... pursuant to application dated ...................... A]p~,],.....~'. ............. , 19.~,,~.., and approved by -the Building Inspector. Fee ~ .~. a .g.Q ............. iulldmgInspect~ FOES[ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT~ TOWN CLERK'S OFFICE. $OUTHOLD, N. Y. Exo ,n d ....... .... .......... Approyed ...................... :..:.....'.' ....... , 1'~..:.:... Pemit No. Applicotion No...L.r~...(..O,. ................ (Building Inspectoj/) APPLICATION FOR BUILDING PERMIT Date ..... ...... ............... , INSTRUCTIONS This application must be completely filled in by typewriter or in ink and ~ubmitted in triplicate to the Building Inspector, wJt~ 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. PIct plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on diagram which is part of this application. c. The work covered by this application may not be commenced before issuance (~f Building Permit. ~, d. Upon approva of th s application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept the premises available for inspection throughout the work. ' shall be occupied or used in whole or in part for any purpose whatever until a Cer, tificate of Occupancy shall have bee,,e,~ No building granted by the Building Inspector. APPLICAT ON S HEREBY MADE to the Building Department for the issuanc~e 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 (~f 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 inspectbrs on premises and in buildings for necessary inspections, (Signature of applic~ant, or name, if a corporation) ........... (Address of applicant) State whether applicant is owner,~lessee, ~ent, architect, engineer, general contractor, electrician, plumber or builder. ...................................................... ........ ............................................................. Name of owner of premises ~:.....'~...~'..~...~r.~..~.. ................................... .......................................................................... \ tf applicant is a corporate, signature of duly authorized officer, t~ I 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...M.~..~ Lot No...~.././.~..2.~.;.~.?...~.:? Street and Number ................. J~.[[ ........ ~ ........ ~J[ ............................. ~[~ .......... , _~ , ~ Municipality 2. State existing use and occupancy of premises and intended use and occDpancy of proposed construction: a. Existing use and occupancy .................................................................................................................................... b. intended use and occupancy ..................... . .l[:~....(~r~m~.c,~:~. ............. ~ ........................................................................ 3. '~NatuCe of work (check which applicable): New Building ....................... Addition ..................... Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work ....~...%~'~....¢,~..~'.. ........... ~ / ~'~ ' "~"'---- (Description) 4. Estimated Co~t ........[~:~..(:;>. ~ ..................... Fee ..... t ........................................................................................... (to be paid on filing this application) 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 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 ................................. He ght ............................................... Number of Stor es ....................... 9. Size of et Front .I. {:~.¢,~ .~.~. Rear .1~..¢;t.....O.~ ................ Depth ....... ~(~. O~. ...... 10. Date of Purchase ..................................... Name of Former Owner ............................................................................ 1 I.. Zone or use district in which premises are situated .................................................................................................... 12. ' Does proposed construct)oh ~iolate any zoning law, ordinance or regulation: .......... ..1:~....<:~...:. ...................................... 13. Will lot be regraded ................................. Will excess fill be removed from premises: [ ] Yes Dq No 14. Name of Owner of premises ....~h~ ....... .~k.~.~ ........ .~.~iT......~i.~..q~;:...~:t:~, .................................... (Address) (Phone No.) Name of Architect .................................................................................................................................................... (Address) (Phone No.) Name of Contractor .... I~,~._.)..~:. ................ ~ %-~....~..~/...(~q)~...~......~~L~Al.~....~4...[~,~l~..,IA - ......... " - (Phone No,) (Address) PlOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions frol property lines. Give street and block number or description according to deed, and show street names and indicate whetl er interior or corner lot. STATE OF NEW YORK. ) .......................................................................................................... being duly sworn, deposes and sa, ys that he is the applicant above name( (/~a~zq.of individual signit~g contract) ~ 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 ~ statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the mann set forth in the application filed therewith. '., ~ TEI1RI L~E E[AK , , da of x~-~ ~ NOTAItY PUBLIC, State. of New Yor,, .......................... ~<. ....... Y ............. -~ .............................. ~t].l t~-6lh~fi., ~, t Notary Pub c -.._N.~x_~.~ ~ ( Q}&~lI~ll~nn,,EnX~tres garch 30,.:;~CX_~..- ~___. ~ ...................................................... .:"~'~""~m'~ .............. ~'"'-'"--'"/})'~nat'"-~';'e'"of"-;pplicant"-"""-"j ...............................