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Home My WebLink About7297-zFORM NO. 2 TOWN OF sOUTHOLD [ BUILDING DEPARTMEN~ TOWN GLERK'S OFFICE* SOUTH'OLD, N:. ¥, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P'REMISES COMPLETION OF THE WORK AUTHORIZED) UNTIL FULL N? 7297 Z Permission is hereby granted to: ,~.,-~...~...~.~.~. ........................................ ........... .q~,rzgl~,...6~.~. ........................ ~ ...... Peconie ~r..e$..$ ~ ,.m..~.ntain a rear .2~..rd fenee ~flt hi at premises ocated at ..~.[.~...O..a..?.r;.o.,]:! AYe. .( .~../.~. ~...,.~i.,.l~..t..R..,). ........................... Pe¢onie N ,Y, pursuant to application dated .......................~ ......... ,,~....J....., ~9.~......, and approved by the Building Inspector. Budding Inspector J ' FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMEN'I TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ..~:.j.,,:~/,,.~,¥ .........~.. ........ , 19..~..:/ Application No..?..~'...~..~. . Approved '' -~ 19.?..Z Permit No. -'~'~ Disapproved a/c .... : :'~*'~"l ......... '.";~ ;~*~=~'~ ...... ............... ~.....~ ......... ~,...,.;~;. ................. .~.....~ ......... (Buildin~ Inspocto[t : ................. D~te ......................... 8'~O'""B' ....... 19"~h ...... INSTRUCTIONS a. This application must be completely filled in by typewriter o~ in ib.k and submitted in triplicate to ~he Building Inspector, with 3 set~ o~ plans, accurate plot plan to ~ale. Fee according ~o ~chedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets areas, and giving a detailed description of layout ofproperty must be drawn ~n the diagram which is pa~ of this application. c. The work covered by this application may not be commenced befor~ issuance of Building Permit. d. Upon approwl of this applicotion, the Building Inspector will issue g Building Permit to ~he applicant. Such permit shall be kept on the premises available for inspection throughout the wor~. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Ceffificate 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 ~he Building Zone Ordinance of the ~own of Southold, Suffolk County, New ~ork, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or ~or removal or demolition, as herein described. The applicant agrees to comply wit~ all applicable laws ordinances, building code, housing c~e, and regulations, and to admit authorized inspectors on premises and in ~uildings ~or necessa~ inspections. ~Signatu~e of applicant, ~(name, if a corporation) ........ .............................. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. 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.: ....~ ...... :~ .m~. ........................ Lot No. ~ ................... Street and Number .;~.v/q,...~.~z~>~::_b..~...~,~.e .......... bc../e(..>~.,3. ............ ! ........................................................................ Municipality State existing use and occupancy of premises and in~ended use and~ occupancy of proposed construction: o. Exisiting use and occupancy ...~t4.,'...b4,t~,i,..i)"...¢,¥;r~,!,.],2~],j~......', ......................................................................... b. Intended use and occupancy ............. ,%'...~;'.,z.~.....:;~.l~!:,,..,T'.o;;,l:....~:~.~3~...~:;~,O~& .................................................... 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .............. Repair .................. Removal .................. Demolition .................... Other Work .}{~.~.'¢....~'.r..~....t.'e~tee ............... (Description) 4. Estimated Cost ............................................................ Fee '"'1'~'~;~0 ........................................ ~to be pai~ on filing this application) 5~ ~f dwelling, number of dwelling units .......... ~ ................. Number oF dwelling units on each floor ..... ~ ...................... If garage, number of cars ............................................................................................................................................. 6. ~f business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Fron~ ............................ 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 construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................... 9. Size of Io~: Front ...... t'g~ ........................................... Rear ............ l'f'~ ....................... Depth ................................ 10. Date of Purchase ........................................................ N~me of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..l~,;~.u...~.j.~t¢, ............................................................................... 12, Does proposed construction violate any zoning law, ordinance or regulation: ...... Z~O ............................................. 13. Will lot be regraded ..-~e .................... Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises ...G¢]~'.~t~.].],...~,~ ................. Address ......i.~.¢.o~,( .......... Phone No ....................... Name oF Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ................... 9~e ................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate dearly and distinctly ali buildings, whelher existing or proposed, and indicate all set-~ck dimensions from propcrty lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. C['E OF NEW YORK, IS S COUNTY OF ........ ~u~i:b%~l~ ........ f ' ....................... w~ii'~.:L.~.,.~:~,De.]..~>~ ........................................ being duly swam, deposes and says that he is the applicant (Name of indiw~ual signing contracf) above named. He is the .............................. T.~)i.~.fl~ .................................................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly quthorized 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 that the work will be performed in the manner set forth in the application filed therewith. Swam to before me this .................... ~. day of ................... ~e.;.....; ........ ~ 19..?~. Notary Public, ....~'...~;.,,,.. ,:.;~ .............. , .......... ¢ ....... ~un~ ...~ ........ L:.~.~,..;~.,...,( ...... C..;:~..~(,~',~?'~.~..:h~,~ .............................. - -- (Signature ~f applicant) Cutr, mtss~on Expires March 30,