The URL can be used to link to this page

Home My WebLink About6644-z FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PEIt~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 6644 Z Permission is hereby granted to: · I~:y~"~tt~t~::l:~ ..................................... ........ ~o---.~' -~-~o~..1~ ..................................... ~ ............. Ga.~.aen...¢~.~y: ...... ~,.~.,, ...................... ~o ..E..x'..9..c..~ .....a~...d.....m. A ~a~;~.~a..a.....b~..~.. ~.gh...£e~:e...~a .. ~o=~...y~ ................................ at premises located at ~.Q-'t;M...~..~J~-....~i~g,,.~i,....J~,OIA..g, tlg.l~.O~,...~ ........................................ ............................. Oak..ll~'..&..tge~t.. 4~h~,e..Bd ............... So,a~ah (~:l.d, · ·. '.,. ....................................... pursuant to application doted ........................~lqa, y ...... ~{) ............ , ]9~,~..., and approved by the Building Inspector. Fee $.$.~0~ ........... E×am ned ..... .......... , ApprovedI,~ ~ ~ BUILDING DEFARTMENT ' TOWN CLERK'S OFFIC£ $OUTHOLD, N, Y. 19.7~ Permit No...~.~...~..~..Z.....~ .... ( g P V APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Th~s application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildin Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. Pz~ b. Plot plan showing location of lot and of buddings on premises, relationship to adjoining premises or public stree areas, and giving a detaded descnption of layout ofproperty must be drawn on the dmgram which ~s part of this applicafior c. The work covered by this apphcation may not be commenced before issuance of Building Permit. d. Upon approval of th~s apphcation, the Building Inspector wdl ~ssue a Building Permit to the apphcant. Such permi shall be kept on the premises available for inspection throughout the work. e. No budding shall be occupied or used m whole or ~n part for any purpose whatever until a Certificate of Occupant shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the ~ssuance of a Building Permit pursuant to th Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o Regulations, for the construchon of buildings, additions or alterations, or for removal or demolition, as herein describe, The apphcant agrees to comply with all apphcable laws, ordinances, building code, housing code, and regulations, and t. admit authorized inspectors on premises and in buildings for necessary inspections. .... ...... .... (Address of applicant) State whether applicant ~s owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises .....~...~..~.J~..L:.~..~.. ..... ..~J..,....~...~../3..S.~...~....I-..~. ...................................................................... If apphcant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electncian's License No ............................................. Other Trade's/~cense No ............................................... Location of land on wh,ch proposed work will bedone. MapNo ...................... (<~'~J -~gO. .......... ~ . Lot No.~_..~..~....~...~.. .... Municipality State existing use and occupancy of premises and in"ended use and occupancy of proposed construction: 3. Nature of work (check whtch applicable)' New Building .................. Addition .................. Alteration ........ Repair .................. Removal .................. Demolihan ................... Other Work ....~...~....l~k...~.. ........................ -~. (Description) 4. Estimated Cost ........... ..~...(i~...O..:..Q..0. .............................. Fee ........ .~.....[..~..:.~ ...................................................... (to be paM on filing thts apphcation) 5 If dwelling, number of dwelhng umts ............................ Number of dwelhng 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, Jf any: Front .......................... Rear ................................ Depth ............... Height ........................ Number of Stories ............................................................................................................ Dimensions of same structure with alterations or addmons' Front ................................... Rear .............. Depth ................................ Height .......................... Number of Storms ............................. 8. Dimensions of entire new construction: Front ..... ,~..'. ..................... Rear ........................... Depth .................... Height ......L~...~ ......... Number of Stories ..................................................................... 9 Size of lot: Front ....................................................... Rear ......................................... Depth ............................ 10. Date of Purchase ...Z..~./..~.~ ......................... Name af Former Owner ...~...~...~..~..1~...1~... ........................ 11. Zone or use district in whmh premises are s~tuated ...................................................................................... 12 Does proposed construchon violate any zoning law, ordinance or regulahon .................................................... 13. Wdl lot be regraded ............................ Wdl excess fill be removed frompremises. ( ) Yes ( ) No ] 4 Name of Owner of premises .~.~..'9.~...~f..~.....~.:..~.~...S..q..fl:..L..~.. Address .G~.9~.en~.~&'f. ytlV~Phone No ...................... Name of Architect ................................................... Address ................................ Phone No ...................... Name of Contractor ........................................................... Address ................................ Phone No ...................... PLOT DIAGRAM Locate clearly and distinctly all buddings, whether ex~tmg or proposed, and ~ndicate all set-back dimensions fron property lines. Give street and block number or descnpt,on accor&ng to deed, and show street names and ~ndmatc whether inienor or corner lot. m 1'5/.,.0C,/4' lq MtlP / STATE OF NEW YORIC _ _ COUNTY OF .,~.~..~..~'...~ ...... ............. .4~..l,.~..,~..~;~../.,.~.~...Z?. ..... ~.,..~Z~:~.~.¢. ~ . being duly sworn, deposes and soys that'% ,s the apphcan: (Name of in&wdual s~gmng contract') above named. ~e ~s the ................................................................................................................................................................ (Contractor, agent, corporate officer, etc ) of said ~or owners, and ~s duly authorized to perform or have performed the sa~d work and to make and file this apphcahon; that oil statements contained in this apphcation are true to the best of his knawiedge and behef; anc thor the work will be performed in the manner set forth m the opphcation filed therewith SwerVe b~e me this B[Otary Pu' ..c '-~' ,e ut lNe;¢ Yor~ No, 3u~l 01375 Q~al ¢l~d ~a I~avzat Cotm~ (k't tdlcnt~ hied ~ueen~ Co, Glerk " l';xpm.~ ~L,.~,~ 30.