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Home My WebLink About7191-z FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N:. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISE~ UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 7191 Z Permission is hereby granted to: ~.r. ~-..~..e.~.. ,~. ........................ .......... .Qu.¢.¢~ D.¢~ g ~e. .............................. ~ ................. ~o ~r.e~L ~d .. m~.iz~.t ~iz~ ..~:~a~...~d .. ~.e~c~ ............. ~ ......................................................... at premises located at ....... ~/.~...PaqllJI.~..AW~ .................................................................. : ............. pursuant to opplicatlon dated ........................... tt~:rtl.....t ,..-., 19...~, and approved by the Building Inspector. Fee $..~.~ ~.C~ ........... ~-~- TOWN OF SOUTHOLD ~ ~//7/~ TOWN CLERK'S OFFICE'. SOUTHOLD, N. Y. App,cotion ................... ~xem~ned .... ~ .(...~.. ....... , - ~ /.. ., Approved ......... L:.! .......... .~.~ ....... , ,~Z~. ~ermi~ No.....ZL.~.~i~ ...... (Building Inspector) / ' [.~ APPLICATION FOR BUILDING P!ERMIT '~ Date .................... ~..~.....!.~......, ~..........,.?~' ~ INSTRUCTIONS ; ~1 e. This application must be completely filled in by typewriter o~ in irk and submitted in triplicate to the BuildingS? Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according 1~o schedule. ~ b. Plot p!an showing location of lot and of buildings on premises, re)ati~nship to adjoining premises or public streets or ~ areas, and giving a detailed 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 issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue ~ Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the worE. ~ e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy ~ shall have been granted by the Building Inspector. APPLICATION IS NEREBY 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 ~or removal or demolition, as herein described. The applicant agrees to co~'nply with all applicable laws, ordinances, bu Id ¼g code, housing code, and regulations, and to admit authorized inspectors on premises and in. buildings for necessary inspections. ~filliam ~eebe (SignotuKe of applicant, or name, if a corporation) .c.~.~.o.~.~? .................................................. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engLqee~, general contractor, electrician, plumber or buildel~ Builder ", Name of owner of premises ...~..,~.,,~,,~..~.....Q..;...g..~..a..~..~..~??.~. ...................................................................................................... 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 ............................................... Location of land on which proposed work will be done. Map No.: ....... ~ ......................... Lot No. Xxx Street and Number ....~./.~..~,e..g.~...8....~.~....A..~...e. .......... ~g.'g...o..~...o.g..~.,e,....., ........................................................................ Municipality State existing use and occupancy of premises and in.~ended use and occupancy of proposed construction: a. Exisiting use and occupancy dwe].]i~g same with rear yard fence . . b. intended use and occupancy ....................................................... ....................................................................... 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work ..... F~t~,, e ..................................... (Description) 4. Estimated Cost ............................................................ Fee ...J.!~.?..0..0.. ........................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ......... .'1. ................. Number of dwelling units on each floor ............................ If garage, number of c~rs ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Fror)t ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with a,lterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ ] 1. Zone or use district in which premises are situated ...... .t!..A.!!...~.i..~.~ ............................................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ...~...O. ................................................. 13. Will lot be regraded ......~P ................. Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises ...~.~..~.z'..9,....G:.~.g..~9.~..o.~ .............. Address ....... ,(~1~1,~C~Q~I,~... Phone No .........~ ............. Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ..... l~r.~...~.~.~ft .................................... Address ....... .~.~.~:.~..1}.~.o.~.... 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 whether interior or corner lot. STATE OF NEW Y.OR~ I c ¢ county ..................... ..~7.;~.4.~..-~....c..~........~~ ................. bein§ duly sworn, deposes end says that he is the opplicom (Name of individual signing contract) above named. 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 and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and tha~ the work will be performed in the manner set forth in the application filed therewith. Sworn to befo~ me this ' ~ ~ c ................. ......... , iqo, b2-0844963 Sullolk