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Home My WebLink About8594-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 PI~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne 8594 Z Permission is hereby granted to: ~r~.m..~:o~..~'erzc e-"g~)'"k)/e'''B~e re ~ct'"De r gert ................... ~4 a.~-i.~el~ ....................................... to ...Er.a o.~L. ~n d,..~ r~t a.],n...2 exx¢ ~,~] g...a.~ .. p~... ~ f~p.1..i.g a~ ~n ............................................. at premises located at .....~bo.tt..~ .............. P~)o.~e-.~o'~e ............ ~ ........................................................ ................................. 1 '6L~'O ....... 5'~e'be-"Dr~'~"- '~:¢,a-~,~ty~q~ .......................................................... pursuant to application dated .......... ~.~ .............. },~r.....j~).,.:....~...., '1~)~6.1.' and a.,pproved by the Building Inspector. Fee $.j~l. GO ........... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exam,ned ......... , proved ................ ............ Application No .............................. Disapproved a/c ..................... ................... (Bui aing nspectorJ [ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely fiJled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with 3 sets of p~ans, accurate plot plan to scale. Fee according to schedule. 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 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 a Building Permit to the applicant Such permit shall be kept on the premises available for inspection throughout the work. 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 HEREBY MADE to the Building Deportment 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 for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. ....... ....... ....... (Signature of applicant, or name, Jfa corporatmn) ....... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................... .......................................................................................... Name of owner of prem~ises .....~..~...~'~...~..~ .~..~./ ....................................................................................... ? If applicant is a corporate, signature of duly authorized officer. (Nome and title of corporate officer) Builder's License rqo ........ ~..r..-: ........ k[ .......................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License Na ............................................... 1. Location o~ land on which proposed work will be dane. MamNo.: ........................................ Lot No ......................... ............................................................................... ?' ................. ;~' ................. '~;~i~i~ii6 ........ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: b. Exisiting use and occupancy ................ ~/...,/,,~ .................... ..~, ........................... ,.~. .......... ..~...~.. ....................... Intended use and occupancy ............... ..~..~...~..~. ...... ~' ..... /..-~. ././. /. ~ ............... 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ...... .~ ......... Repair .................. Removal Demolitior. .................... Other Work ....... , ...... ',?"~"v ', ....................... (Des~r pt on) 4. Estimated Cost ................... ~, .......... ~....~ ........................ Fee ....................... .';..~ .................................. : ........................... ." " (to be paid on filing this application) 5. If~d~e~i'~,~umber of dwelling units ............................ Number of d'~J~ng~,.., units~o~lec~... ......................... If garage, number of cars ............... ~...~...~..~...~-,,j. ..................... .~. .......... .'~..~ ........... ~..~ ................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of ~ structures, if a~:7.;~th .................... Height ...................... i. Number of Stor~..~ ...................................................... ~..-~--_.-,, .......................... Dimensions of same structure with alte~'- ............................... ~'- I~ear-r ............................ Depth ................................ Height ~mber~fSto~s ................................ 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 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 ...... ;L.~...-.¢...~ ................................, Address ......... ~ /;._~,~ ............... -.. ,-~< Phone No...:,..,,~..,,.¢..,/'~ ' ' ~ / Name of Architect .............................................................. Address ................................ Phone No ....................... Nome 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 and indicate whether interior or corner lot. STATE OF NEW YORK, l c ¢ ~ ...................... ~t,4~it~..~T.,...?~.14~O~....,. ........ ;....:...being duly sworn, deposes and says that he is' the applicon, (Nome of individum signing contracT) above named. He is the .................................................... ¢4~1~'~,'~,,,0~ .................................................................................................... ~ (Contractor, agent, corporate officer, etc.) of said owner or~.~r~ and is duly' authorize'd to perform or have performed the said work and to make and file this opplic41,~lr~",~tatements contained in this application are true to the best of his knowledge and belief; and that the work will be '[~'Nf~ormed in the manner set forth in the application filed therewith. Sworn to before me this%NX .......... o, Notory Publ~c~bli .............................. 8t1..~.~1.~ ..... Cout~tY .~~..~..~' ............................. ELIZABETH ANN NEVILLE NOTAITy PUBLIC, Slate o~ New Yor~ No, 52-81~5850, SuItol/( County