The URL can be used to link to this page

Home My WebLink About6760-z FOEM NO. 2: TOWN OF SOUTHOLD BUILDING DEPARTMENT! TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISE~S UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) N9 6 7 6 0 Z Date ...................~13~.~'.-......~t.~. .............. , Permission is hereby granted to: Jeh~ · &..~,l~s.t.~p-..¥a~eu~e~.$~ ............. .......... · ]~ex-..1 .......................................................... ............... ~qal~loa....~,~, ............... , ................. to .e~e.e~ ..~ae f,:Lona;L .. (.1.0.. xm,ttt~ ) ...of...l~o~.ta~le ..g ,'~'~nhou~,~ .................................. ...................... ~ g-~ iL~,~-ta~a.~- · .~ e.~ .................................... : ......................................................... at premises located at ..... ~/~....~r~t..;j~...~d ........................... ~ ......................................................... ................................................... Peo~JLe ....... ~,~, .................. + ......................................................... pursuant to application dated .........................J~L~ .......~-7"'"'"', 19--7~.., and ~pproved by the Building Inspector. Fee ouilding ~nspector ~ FOP,,I~ NO. 1 TOWN OF $OUTHOLD ~, BUILDING DEPARTMENT TOWN CLERK'S OFFICE! Examined ] 9.1~..~... Approved 19.?..~.. ~ermit ~o..~..Z.~..~...~ ...... .......... ...... .......................... APPLICATIO~ FOR BUILDING P[RMIT ........... ....... .........._ 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. Plot 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 ofproperty must be drawn 0n the diagram which is part of this application. c. The work covered by this application may not be commenced befor~ issuance of 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 pa rt for any purpose whatever until a Certificate of Occupancy shall have been 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 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, build[ng code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inFpections. ,~ ,~'.. ~ :~//[Sig.natu~e.°f applicahfT'or nfl/ne, ifa corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, genergl 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 land on which proposed work will be done. Map No.: ....~ .................................... Lot No ......................... Ail._.< tv~ ,4 l lxl J~ .~ ~ /~ Street and Number .(.Y/. ..........c/..::. .......................... ~. ...................... i ......................................................................... Municipality 2. State existing use and occupancy of premises and in?ended use and occupancy of proposed construction: a. ExisitJng use and occupancy ...................................................... ~ ......................................................................... b. intended use and occupancy ..../~...:~.~..~./..C.%.~..,.(i..'~....~..(~.~,..~. ...... ~.(~.~.~...~.;.~.~.~.~..?.(..~...~g.q~L. 10. 11. 12. 14. Name of Contractor ............................................................ Address ................................ Phone No ......... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensi property lines. Give street and block number or description according to deed, and show street names and whether interior or corner lot. Nature of work (check which applicable): New Building'S......~..x. ......... Addition .................. Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work ............................................... . .... (Description) Estimated Cost ..~...~..?..~..~....~.~.. ...................................... 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 ................................................................................................................. ~'Z~'.~"t-'r-~'"~'~'~'~l If business, commercial or mixed occupancy, specify nature and extent of each type of use .~.~.~':!~..U..5.!=~ Dimensions of existing structures, if any: Front ............................ Rear ................................ -Dep~ .(~./?.~ i.!!.!..~,) 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 Jot: Front ........... .~...0....O....~. .............................. Rear ..... ~..J'...~...i ....................... Depth .,,~...~...~...O..~:~ ........... Date of Purchase ................................. /...~...7..~.. .......... Name of Former Owner .....~.t....~..(].~.O..~..~../. .................... Zone or use district in which premises are situated ........ .,¢~..~./.~..I ............................................................................ Does proposed construction violate any zoning law, ordinance or regulation: ......... ,(~./..~.. ...................................... Will lot be regraded . ...... ../~/....O. ............. Will excess fill be removed from~premises: ( ) Yes O() N~, Name of Owner of premises~./~.../.V.....~...~.~..~../'T....~.4~ .~.!...~.~.?.'¢Ad~dCe~/s~.../.~,~;.~.~./. ............ Phone No.~..~..~...,"~,.~...~ ~ Name of Architect .............................................................. Address ,....~.~./,~...~',Z...~,/.~,,, Phone, No ...................... )ns from indicate STATE OF NEVJ/-..'Y~OP,~,/~,/~' ~¢ c COUN'rn'XOF ......... ~~~~~ ............ duly sworn, deposes and says that he is the ppi being~/(Nam~'~f indiw'duaJ sign'i~ng contract') above named. He is the ..................................... ~...~...,J..~ .......................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and ~o make and file this application; that all statements contained Jn this application are true to the best of his knowledge and bi ief; and thor the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this r'~ /q ................. · .-~...~. c~of ..... ~~....~,.._ .......... , 19..~.,,~. x'~////// ~'~/ ,~ ,/~ ' Notary Public, ....~.~-.~:~r.. County ...~..~.....l/.~~ ...... ~ ..... /~,/ ~// (Signature of~/~pplicant) T£RRI LEE ELAK ;/ ~ NOTARY pUBLIC, State of New No. b2.6168295 (~lJal~flec~ ffl Sullolk Coullty 19~] Cominismon Expires March 30,