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Home My WebLink About7267-z FOI~M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT: TOWN CLERK'S OFFICE SOUTHOLD, N~. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne 7267 Z Permission is hereby granted to: ......... ~t ~.4L~uek .............................. ~, ................. to ..~z'.ee.t..~r~..~z~ta.t--- e,..~2.....po4~. ...... ~,$JL.F. dn=e......~2.".....z'~roz~...p~.o'p.er.t¥ l~b~e at premises located at .,t~l.~..~,~..]~.~e ......... , .............. ! ................................ i ........................ · .~e~o~.~...~.~f.,.. ~' .....i ........................... ' pursuant to application dated ........................... ~,~......~-6 ...... ~i-.,., .19.~,~.., and approved by"the Building Inspector. Fee $..15 ,,:Q0 ........... Building Insbector / TOWN OF SOUTHOLD; ~/?, _?/~/C ~* ~ ~ BUILDING DEPARTMENT / -/, ,~ ~-- ~ ~ TOWN CLERK'SOFFICE~ r ' -- ........ ~isopproved (Building InspeCt) APPLICATION FOR ~UIL~IN~ ~ERMIT ~ I~STR~CTIO~S o. This opplicotion must be completely filled in by typewdter o~ in ~nk ond submitted in triplicoto to the Buildin~ Inspector, with 3 sets of plons, ~ccurote plot plan to scale. Foe *ccordin~ ~o schedule. b. Plot plon showm0 Iocohon of lot ond of buildings on premises, relohgnsh~p to od omm~ premises or public streets o oreas, ond 0ivin0 o detoiled doscr pt on o{ Ioyout ofproperty must be drawn Bn the dio~rom which is part of this opplicotion.~ c. The work covered by this opplicotion may not be commenced before issuonce o{ Buildin~ Permit. d. Upon opprovol of th~s ~pplic~tion, the Buitdino Inspector will issue ~ Buildin~ Pormit to the opplicont. Such permit sholl be kept on the premises ovoil~ble {or inspection throughout tho work. e. ~o build~n0 sholl be occupied or used in whole or in p~rt {or ony purpose whatever until o Certificme of Occuponcy sholl hove been or~ntod bg lbo Buildino lnspector. ~ ~klqAll~ .15 H[RE~Y MAD[ to the ~uildin~ Deportment for the~Jssuonce o{ o Buildin~ ~ormit pursuont to the ~ui~oin0 ~one ~r~inance ot the Town of Southold, Suffolk County, Mew York, ~nd othor opplicoble k~ws, Ordinonces or Re~ulotions, {or the construction of buildin~s~ odditions or altorotions, or ~or remowl or demolition, os here~n described. The opplicont a~rees to comply with ~11 opplicoble bws~ ordinonces, buildlno code, housino code, ond reoul~tions, *nd t~ odmit ~uthodzed inspectors on premises ~nd in buildinos {or necess~ inspections. (Signature of applicant, or name, if a corporation) (Address of opplic~nt) State whether applicant is owner, lessee, agent, architect, engineer, general contract_9_or, 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 ............................................. *~:/0 ~ J'~ Other Trade's License No ............................................... ,~'2. ~ //J/~.J'l'll/J, 1. Location of land on wh~h~ropose~ work)~,!ll be d/~e. Map No'./~. A~lJr~ot .No.~~__ .&L/~1~ / ' Municipality 2. State existing use and occupancy of/,¢) ~/~- . / ~'~ . #~ .premises and_intended/use 9¥d,- --' ~- ~'~. occ,,ul~ancy~,/~, [" of proposed construction'. 3. Nature of work (check which applicable): New Building .................. Addition ................ .~?eratJo~n .................. Repair .................. Removal .................. Demolition .............. ...... Other Work .............. ~-/-~,~ ................. -- (Descr'~ion) 4. Estimated Cost ............ .~...~.f...~..~ ........................... Fee ...................... ?..~.....~....~....~.. .................................................. (to be paid on filing this application) 5. ~lf dwelling, number of dwelling units ............................ Number of dwelling 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, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new constructionl Front .................................... Rear ............................ Depth ........................ Height .................... Number, _gf Stories ............................................................................................... ]...0. 0 /...-~..-z'S .............. 9. Size of lot. Front ............... l..~.....~.. ............................... Rear .. ................. Depth ...... .......... 10. Date of Purcha~se ..~ ..................................................... Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning Iow, ordinance or regulation: ........................................................ 13. Will lot be regraded .............. , .............. W~ill e,x, ces~ fill be removed from premise,~: (A) Yes ( ) No 14. Name of Owner of premises .................. Address~...~.~ .,~..;. Phone Nv. 7t~. ............... 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 dimensions from property lines. Give street and block number or description according to deed, and show street names ond indicate whether interior or corner lot. STATE OF NEW~O~ /~ ~c~ ' ~ t~'~L""~ ~"~ COUNTY OF ........... ' ....... ' ......~ -~ ...... ~ ............................... '....~ ................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ............................................................ ; .................................................................................................................... (Co?'actor, agent, corporate officer, etc.) of sold owner or owners, and is duly authorized to perform or have per:Formed the said work and to make and file this application; that oil statements contained in this application ore 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. ~ - / (~rgn~e or app~rcant~ No, 52.0344963 Su~(o~k Coun~ ~