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Home My WebLink About6753-z FORI~ NO. 2 TOWN OF SOUTHOLDi BUILDING DEPARTMENT TOWN CLERK'S OFFICI SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6753 Z Date ........................................................ , ] 9 ........ Permission is hereby granted to: T~u Fork Feaee Co Ine A/~ Robel-I~ Neyer Nattit~ek ; to Erect and mainta&n ~ft eha~n l~k fenee i. rear ~ area at premises located at ~t 7 ~el Co~tr~ E~tatea .......... ....... ................................................... pursuant to application dated J~ty ~ ~ .................................................... ~..., 19 ........ , and approved by the Building Inspector. Fee $....1...~..0....0~., ......... ...... .... ............ ,, ...................................... 19 ........ Permit No Disapproved ~/c ..... ~ .......... ~ ........ : ............... ~. ............ ......... ...................... ................... ~ - (Buildin0 Inspecto~ APPLICATION FOR BUILDING PERMIT 19..x~..~.,,. 1NSTRUCTIONS a. This application must be completely filled in by typewriter or~ Inspector, with 3 set~ of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of Jot and of buildings on premises, relatibnship to adjoining premises or public streets areas, and giving a ~etailed description of layout ofproperty must be drawn ~,on the diagram which is part of this application. c, The work covered by this application may not be commenced before ~ssuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue shall ~e kept on the premises available for inspection throughout the wo~k. e. No building shall be occupied or used in whole or in pa rt for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector, APPklCATION IS HER[BY ~ADE to the Buildin~ Doportment {or the issuonce of o Buildin0 Pormit pursuant to tho Buildin~ Zone Ordinanco of the Town of Southold, Suffolk Count~, ~ew~York, ond Other ~pplicoble k~ws, Ordln~nces or Ro~ul~tions, for the construction of buildinos, ~dditions or olterotions, or ~for removol or demolition, os herein described. The opplic~nt o~rees to comply with ~fl oppficobfe bws~ ordinonces, ~dmit outhorized inspectors on premisos ond in buildings for ne~essory i~spections. (Si~nat0ro 6~ appllc~n~, or nome, i{ ~' corporotion) (Address 6f' applicant) Stat%~whether applicant~ is owner, lessee, agent, architect, engineer, genei'al contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer. (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 and on which propos~c~w~k/~'ll bo_d~lne. ~no.:, ~,,, ..~. Street and Number /~/~/~ ~J , ~- ~*~'~ / ~C // ........ ........... Municipot~ty 2. State existin~ use ond occupancy o{ premises ~nd in~ended us* ohd occuponc~ of proposed construction a Ex s t no use ~nd occupancy ~¢.~ ~?:~ ~.j ~, ~ b. Intended useondoccupancy ..... ~./. ................ ~.....~ .............. ~ ................... ~ ......................................... 11. 12. 13. 14. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .............. Repair Removal Demolition .................... Other Work ' ................................................. ~/~, .u.~. ~ ;~ .......~ .... (gescripti~'~ Estimated Cost ..........~?z~ ,'~ ,~ -,.~,/g~...~..:.,.(~..~ .......................... Fee ............................'-'~ ~ ' ~..~" ~.., .C,-4'...~ ......................................... (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 occupancy, specify nature and extent of each type of use ............................ 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 ................................ Dimensions of entire new construction: Front .................................... Rear ............................ Depth ....................... Height .................... Number of Stories ..................................................................................................................... Size of lot: Front ........................................................ Rear .......................................... Depth ................... : ............ Date ef Purchase ......................................................... Name of Former Owner ~ ..................................................... Zone or use ,diStrict in which premises are situated .................................................................................................. Does proposed construction violate any zoning law, ordinance or regulation: ...................................................... Will lot be regraded ......... ~'"/~'","~'" excess~l,~be~qj-~, f,r°(~O/~'~/m)~ (2 ¥~e7 (') No Name of Owner of premises' .~l~,~U~..~.C,0,..ff'..J,.~(.~., .~~.~ .~..~.,/~. ;.z..,..~ .~.~..¢,¢l~ho, e No...~.:.'.~, C.~. ~(~.~f"' 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 dimensio property lines. Give street and block number description according ~o,de, ed, and show street names and whether interior or corner lot, ,~/' ~- ~o/ ~ )Q ~' ,~ · STATE OF NEV'/_,.~OR~,,~, /J,, [~, (Name of ind[vidua~signing above name~ ~ 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 an this application; that all statements contained in this application are true to the best of his knowledge and belief that the work will be performed in the manner set forth in the application file~,therewith. Sworn~..[~.to~efore me this ~/ ~,,~~ ~// Notary Public, . ...... ~.. ~_~ ............. County TERRI L£E El.AK from ndicate Jicat~t file and