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Home My WebLink About6646-z I~ORM NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING FERJ~IT (THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6646 Z Permission is hereby granted t~: ~ .. ,T.~.m..e s..~.,., j~Lay. ................................................ .... ..6.~.t..~. ..... .r..~.g~.a~. ........................................ ......... ~.~:9.~1~ ...... .~.,.~., .......................................... .- to ~.~,;k~..~t...~l,d&.~t.o~'...cm,..ez~Ls.ti~g..due:LZJ.u~ ............................................................... at premises located at .~'~'.L~,g.,¥~'.,..Q~£...¢$~a~.s...R~d ............................................................ .................................................... C.u~h~g~....~.~'.~ ........................................................................ pursuant to application dated ........................~.~.~......~. ............... , 19~.~..., and approved by the Building Inspector. -' Fee $ J.~.,~.C~ ............ Building Inspecti FORM NO. ! TOWN OF SO~TSOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ^pp, cot,on ............. Disapproved a/c ........................................................................................... APPLICATION FOR BUILDING PERMIT Date ........ .(/Z ............................ , 19.,.~..., ."~. INSTRUCTIONS a. This apphcatlon must be completely filled in by typewriter or in ~nk and submitted in trlphcate to the Budding Inspector, ~ 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 adjoimng premises or public streets or areas, gwing a detaded description of layout of property must be drawn on dmgram which ~s part of th~s apphcat~on. c. The work covered by th~s apphcat~on may not be commenced before ~ssuance of Building Permit. d Upon approval of th~s apphcation, the Budding Inspector will ~ssue a Budding Permit to the apphcant Such permit,shall be kept the premises available for inspection throughout the work. e. No budding shall be occupmd or used m whole or m part for any purpose whatever untd a Certificate of Occupancy shall have [ granted by the Budding Inspector. APPLICATION IS HEREBY MADE to the Building Department for the ~ssuance of a Budding Permit pursuant to the Budding Z Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances or Regulations, for the constructed buddings, additions or alterations, or for removal or demoht~on, as hereto described The apphcant agrees to comply w~th all apphcable k- ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and m buildings for necessary ~nspectic L~//j~lgnatLIre of applicant, or name,~t% corpo t on) (Address of apphcant) State whether applicant is~lessee, agent, architect, engineer, general contractor, electrician, plumber or built Name of owner of premises ........... ...... ./~r.m.~.. ................................................................................ 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 Lmense No ..................................................... Other Trade's License No ................................................... 1. Location of land on which proposed work will be done. Map No .............................................. Lot No ....................... Street and Number ...... ~..~..~..~.........~.,..,F...,~.~,../.?..~.T..~.......~.~.:.....~....~..~..,...~,..~.,~.~..~.£....A?.& .......... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and .... . .... . ................................................................................................................................ fl b. Intended use and occupancy ................................................................................................................................ 3. Nature of work (check which applicable): New Building ....................... Addition.......,...,........./'~ Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work ................................... { Description) 4. Estimated Cost .................... ..~..:...~...~.. ............ Fee ................................................................................................ (to be pa~d on flhng th~s apphcat~on) 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 occuoancy, specify nature and extent of each type of use ..................................... 7. Dimensions of existing structures, if any: Front ..... ~..~.......,~/...X'~ear ..... ?...~.....~ ....... Depth ...... .~..~........~....~.- ........... Height .......... .3'....~..7. ...... .r..~....../...~....~..~ .............. Number of Stories .................... ./. ....................................................... Dimensions of same structure with alterations or additions: Front ....... ~'...~.:..../~.-.?. .... Rear ........ ~..~.. .......................... Depth ........... ..~....'~'.....-~..../-.: ................ Height ....... .~....~...~.......~.i..../..A....~,..~.. Number of Stories .......... ./, ........................... 8. Dimensions of entire new construction: Front ....... ./..~.....,f.....~... Rear ....... ../...¢'......~....~_. .... Depth ....... /.,..~......./~....7'.. ....... Height ............. ~...../'...~.'. ........................ Number of Stories ...................... ./. ............................................................... 9. Size of lot: Front ........ /.~...~..:..~.L. ............. Rear .......... ../...~....~.,..~....~., ............. Depth ....... ./,.~.~..*....~..~.. ....................... 10. Date of Purchase ......... ~,A~..~./..~..Z. ..... Name of Former Owner .......... ..~'...~...~....~.'~ .................................................. 11. Zone or use district in which pre' mises are situated ................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .......................................................... 13. Will lot be regraded .................., ............. Will exce~ fill be removed from. premises: [ ] Yes [ ] No 14. Name of Owner of premises ...... .~..~.~...~...~'.......~..:...../~'.~.~.. ....... ~..~../....~..'..~...~.~.....?/~.~..~.. .............. ~/.~.&..:.~..~.,¢.~ ............. (Address) (Phone No ) Name of Architect ...................................................................................................................... i~'~'~"~'~'"-"': ....... (Address) Narne of Contractor ................................................................................................................................................. {Address) (Phone No PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fro property lines. Give street and block number or description according to deed, and show street names and indicate whel er interior or corner lot. STATE OF NEW YORK, } SS COUNTY OF ........... Stl~.,fo..~. ~ ....... ) James B. R~ ............ '(~l~'~'~jl'~'g,~,du'~i szglz.zg contr, ct) being duly sworn, deposes and says that he is the apphcant above nam He ~s the ~er (Contractor, agent, corporate officer, etc.) of sa~d owner or owners, and ~s duly authorized to ~rform or have performed the smd work and to make and hie th~s apphcat~on, tha statements contained m th~s apphcat~on are true to the best of h~s knowledge and behef, and that the work wdl be performed ~n the ma, set forth m the apphcat~on filed therew.th 7%~ ....... day of .... J~... ~HA ~, JACC~ 7~ . ~. N [ ' ~57 nty .. /~ml~pn ~pires Mar~ ~_ ~q~ ~ (Signature of app~t)