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Home My WebLink About6710-z FO~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT~ TOWN CLERK'S OFFICE SOUTHOLD, FI;. Y. BUILDING prERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) N? 6710 Z Permission is hereby granted to: u&~ ~.... ~..~,a.l~_.y...~a~.t~8 ...... ! ................. ........ $6.1......R~ck~wa.~..Ave ............. ................. ............ ~.~,~O,~a...q.;Lty... ~ ~ Z ~ ........... , ................. to .. ~,X~c.l~.. ~md...~a~t a~...~ ~oc~,ad~a...2en¢~., ,...h,_e.~. i~'.r en ~...:~a.~d.. &.. ~o£-~.. 6 "-. ~n..-s ~de .... ~..r.e~.....~n..~,/S.....~.,L.:. .................................................. ......................................................... at premises located at .......~./~-....;Ba.p..Av~-..(.~k.~uk... -~.).......~U%eltO~e ................................. pursuant to appJieation dated .......................... ~.~.~. ....... 1'0'""!'"" ]9~.~,., and approved by the Building Inspector. Fee $...~.~.. D.O. ......... Examined Approved TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE: SOUTHOLD, No Y, Pemit No. .2~....O. ......... Application No. (~,.:~,..,~.,C,), ............... APPLICATION 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, with~ 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, relationshi.p 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. ¢. 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 Buildin~ Permit to the applicant. Such permit,shall be kept Chi the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose wh~atever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuancp of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable iLaws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. ~he 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. ........ .................... (~ignature of applicant, or name, if ~ corporation) ...... .................... ~ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, gen~iral contractor, electrician, plumber or builder. ........ ........................................................................................... .............................................................. Name of owner of premises ...~..~J.~..~;.l~.~-.......~?..,....~ ......... ~.¢..~,.~....~...7.:...../.l.!.t2. Lb.~,.~.:.%.~ft.. ........................................ If applicant is a corporate, signature of duly authorized officer. I Name and title of corporate officer) Builder's License No .......................................................... Plumber's License No ......................................................... Electrician's License No ..................................................... 0 her Trade s License No ................................................... ~ ~ . 1. Location of land or, which proposed work will be done. Map No ...... ~...~.;:.~...].....~..~...~.~...~.~..~, .'.~_ot No ......................... Municipality 2,State existing use and occupancy of premises and intended use and occupancy of proposed construction: a, Existing use and occupancy ................................................................................................................................... b. Intended use and occupancy ................................................................ ',...~.~J]~..~ .............................. 10. 11. 12. 13. 14. I~ature of work (check which applicable): New Building ....................... Addition ..................... Alterador~ ...... ; ........ Repair ......................... Removal ......................... Demolition ........................ Other Work ....... .~. ~'~ ..)~'.. ~ ~; ........... (Description) ' Estimated Cost .../~..././.P..l ........................... Fee" (to be paid on filing this application) If dwelling, number of dwelling units .................Number of dwelling units on each floor If garage, number of cars ............................................................................................................................................ If business, commercial or mixed occuoancy, specify..~,.,..z..~,#...,nature an..d..¢xten r of each type of use ..................................... Dimensions of existing structures, if any: Front ...../..~.~...~...~.~R~ar ........................... Depth ................................... Height ........................................................... Number of Stories ............................................................................. Dimensions of same structure with alterations or additions: Front .......................... Rear ......................................... Depth ............................................. Height ......................................... Number of Stories ........................................ Dimensions of entire new construction: Front ......................... Rear ............................ Depth ................................. He ght .............. Number of Stories ........... t , z z'~"~¥"~'r~)~ ............ ~ ....... Size of lot Front /~.P. Rear ..... ~...?.. ........................ Depth ......... z.~.~..La~.5.m.~.~.~..~ ......... Date of Purchase ........~./...z;..~.~..7.?. ........... Name of Former Owner/.~...~.?.;..~....~..~...~...~..-:~...J....~./,~;.~.~. ......... Zone or use district in which premises are situated ..................................................................................................... Does proposed construction violate any zoning law, ordinance or regulation: ....~ ................................................. Will lot be regraded .................................. Will excess fill be removed from premises: [ ] Yes [ ] No Name of Owner of premises ../J~..C..~...~u'..~. .......... [.~./../~./.f.~.~...~j....~...~..q:-.~. ....... .~..:.C.~..;././...~...,)..~ ...... (~./..~.,~..~...~... (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,~,z..~..,i/.;.r_ l '/ ) COUNTY OF ....... ~.~...~:.fY,..,..,~....~..~... ~ .~. ......... ) ................................................................................................... being duly sworn, deposes and says that he is the applicant above named, (Name of individual si~ing contract) He is the (Contractor, agent, corporate officer, etc.) ~ owner or owners, and is duly authorized to ~rform or,~med the said work and to make and file this application; that all statements contained m this application are true to the bes[[~wledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. .............................................. ......... ...... Notary Public, ,.~....County ...~7.~.~.~L..~.~....~.~.~.~.~,..fJ ............................... AVENUE 4-.I 0 0 SURVEY' FOR EUGENE B.,JFL ~ SALLY MARTENS AT CUTCHOGUE TOWN OF SOUTHOLD SUFFOLK COUNTY~ N.Y. SCALE: S~P'F 30, 1971 INTERiCOUNTY TITLE GUARANTY ~ MORTGAGE CO. EUGEN~ B. JR.~ SALLY MARTENS SOUTFIDLD SAV NGS BANK ,~C-8~.,.¢: [2. ~:: L~D 5Ut:~VEYOuR