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Home My WebLink About7058-z FORM NO. 2 TOWN OF SOUTHOLD'~ BUILDING DEPARTMENT TOWN CLERK'S OFFiCE i SOUTHOLD, N~ Y. (THIS PERMIT MUST BE KEPT ON THE PREMIStS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°. 7058 Z Permission is hereby granted to: ~i~...iLo~k ..Sld.~g ..d...t~.~ £i~4~ ...~.o .......... ....... ~;,~,u~..,av~ ................................. '. .................. .............. ~.tti.tu~¢ .......................... ; ................. ~ ~.ct and maintain a ~round sign ~t ~ 1~2f~ (doubl~ face) at premises located at ...... .,S./:.S.....~.~..~...d...,~.Y.9.......O.~.°..~.~:tg....~P.~..~L~.o.~:...L..~. ................................. .................................................. ~;.t.i~.uCk ....~L..~[ ,. .......................................................................... pursuant to application dated ............................. ~'~l~ ....... ~ ...... , 19...~.~, and approved by the Building Inspector. Fee $.9 ~,(~ .............. ........ t,..~ ......... '"6t'ii,~;;,'~"i'n~'~;',;'; ....... Y" ............ FOI~M NO. 1 TOWN OF SOUTHOLD BUILDING DEpARTMEN~ TOWN CLERK'S OFFICE Approved 19 7¢ ..... '7~ ~ ~ ................................ INSTRUCTIONS o. This application must be completely filled in by typewriter o¢ in ibk and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according (o schedule. b. Plot plan showing location of Jot and of buildings on premises, relatidnship to adjoining premises or public streets or areas, and giving a detailed description of layout ofproperty must be drawn ~n the diagram which is part of this application. c. The work covered by this application may not be commenced befor? 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 wor~. e. No building shall be occupied or used in whole or in part for any purj~ose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the iissuance 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 ce, reply with all applicable laws, ordinances, buildi,hg code, housing code, and regulations, and to admit authorized inspector~.on premises and in buildings for necessary inspections. ....... ........................... .... ..... : ............ (Address of applicant)' .: State whether applicant is owner, lessee, agent, architect, engineer, gener61 contractor, electrician, plumber or builder. ............................. ~,~,:~,.~.'.~..,, ............................ ; ................................................... :, ................................................................ If applig~ant.js a cor~P0/~)e, signature of d¢¥ authorized officer. ' '- ;i ......... Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... ')~ ~ ~ 1, Locatian of land on whic~pr~posed ~rk will be done. Map No.: ....,...~,~.~.~..~.Z,~,~?i....l.....~ Lot No ........... Street and Number. ,m:..-CC./~,.......~..~.-.~.......~...~...,C'.~..~Cr~**~ .......... ~,~... ........ / ! Munici/IC'ality 2, State existing use and occupancy of premises and intended use anc~ occupancy of proposed construction: o. Exisiting use and occupancy ..... ?.~k.h.~..M~.,.~ ............... ~ ......................................................................... b. Intended use end occupancy ..... ~d~.h.~.~..%~.{~;.~C~¥;~(~ ........ : ....................................................... 3. Nature of work (check which applicable): New Building .................. Addition .......... .~ .... Alteration ................. epmr .................. Removal .................. Demolman.........,~. ......... Other Work ...t..~f-.'~. ............................ ' ~ ~ .. - ,-1 (Description) 4. Estimated Cost ............................................................ Fee ....[ .................................................................................... (to be paid on filing this application) 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 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 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 .................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded ............................ -- -- ,~ ,~Will excess fill be removed from,~.__ ,, , , ,premises: '( )Yes( ) No 14, Name of Owner of premises ....~..u~,~/~,.~'~.(~-..~...'~..~.f.~.. Address ..i~-~.~hone'~ /r~,~ No. ~..~.~..'1 .~.!...~..~' Name of Architect .............................................................. Address ................................ Phone, No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locat.e clearly and distinctly all buildings, whether exi,,ting or proposed, and ndicate all set-back dimensions from property hnes. G~ve street and block number or description according to kleed, and show street nQmes and indicate whether interior or corner lot. / COUNTY OF ...._..,,:~:..~.....)' ' ................................................................................................ being duly sworn, deposes and says that he is the applicam (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 ail statements contained in this application are true to the best of his knowledge and belief; and thor the work will be performed in the manner set forth in the application filed therewith. Sworn to be,~:~ me this ,~ /~ ~ ~ da of ~ JUDITH T. BOI(Er~ / - ~m of applicant) ~JaW Public, State of New York 7 fqo, 52-0344963 Suf[o~k Count~