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Home My WebLink About6015-Z FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERIC'S OFFICE SOUTH-OLD, N.. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N° 6015 Z ..... .�. ................. 19.,�.4-- Date .... ... ...�. 4 I Permission is hereby granted to: ^ ,c ............ .Y. :.t-r..... :°:... .� . ................................. lO ... ....( ..� :....... ..Cam.n•.•r .f:9,n.�:......... f :.... ,-�f• :«">.. .Lir :... ....... Fti �4 at premises located at '�4......: -- '.::.'... :...............�.'..............�.i^r ... '. .l `....�!.::'�-,............. .�qy yq F� ...................................................per.rl�••iT"..✓•h•�•d .. •..............................................................................• •...................................................................... .� ................................................................................• pursuant to application dated ................�'7()/ .1........ . .... .�............ .. 19. 2...., and approved by the Building Inspector. Fee $1. .. Ij I' ..........................Building..ln....., r ` ................... alp a 10 L't 1, ld;J FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 6 /y Examined ........... ..............�...�........, 19.7.2 Application No. ................................ (yam Approved ..................t,'t.......�.�.......... 197�'.. Pem ...it No. ..(;��.....1. �� ................. Disapproveda/c ............................................................. ....... ............. .................................................................................... ........ ..................... . 642— ....................... ..................................... .................................. (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ................................................. 19............ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector., with 3 sets of plans, 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 or areas, and giving a detailed description of layout of property must be drawn on 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 Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffotk 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 a i ant,or name, if a corporation) ........................ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......................................d!:'k.APEI� ................................................................................................................................... Name of owner of premises I± AJ K'V / " .0 I .............. .....-....... ........................................................................................ If applicant is a corporate, siig ature of duly authorized officer. .....................................1.`.: . ...................................... (Name and titfe bf corporate officer) 1. Location of land on which proposed work will be one. Map No.: ............. Lot No. ............................................. Street and Number � �:. ��::, ...............::-��- ....... ..... ................................. ............ ::s... ........... .. . .. ............ • Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .................................................................................................................................... b. Intended use and occupancy .........�. ..... . . ....................................................................................... 3. Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration Alter ation............... Repair ......................... Removal ......................... Demolition ...................... Other W o r ......... „.�.......(Description) p-Q 4. Estimated Cost .......I.o..�?............................... Fee ................................................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ..A)/A.... Number of dwelling units on each floor .....AJ/I.e4....................... If garage, number of cars .......... Y/ 6, If business, commercial or mixed occupancy, specify nat re and extent of each type of use .....A / ................... 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 enFrI., ew construction: Front . Rear .�..C7.1�� p �5.-A.,..... . , ... ............. De th ........ ............... Height ...........7 . ......................... Number of Stories ...f........ . ....................................................................... 9. Size of lot: Front ... �? ............... Rear ........ G..... .. ............; Depth ..............7a� .:................. Height ............:....................................... Number of Stories ...................................................................................... 10. Date of Purchase .... . 1.,%?.....` :............... Name of Former Owner ............................................................................ 11. Zone or use district in which premises are situated...................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..N. ................................................. 13. Will lot be regraded . N.v.................... Will excess fill be removed from premises: [ ] Yes [ ] No 14. Name of Owner of premises �ft�/z� Al u'. t!`�.....:?. r (Address) (Phone No.)�� Nameof Architect ..................................................................................................................................................... (Address) (Phone No.) Nameof 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 wheth- er interior or corner lot. l 7 3 l-{o u S 3 _� 11 D MCA 0 W G. A tj E STATE OF NEW YORK, ) SS ' COUNTYOF ......................................................) ........ %.!!!�..� .. .......... .. (�.�/� ............................. being duly sworn, deposes and says that he is the applicant above named. (Naof in ividual signing contract) Heis the ................................................................................................................................................................................................................. (Contractor,agent, corporate officer,etc.) of said owner or owners, and is duly authorized to perform r have performed the said work and to make and file this application; that all QiTstatements contained in this application are true to the ,p{f h,%:k�6gfe Z,and Belief; and that the work will be performed in the manner if YUb�i�c; ate e Yor set forth in the application filed therewith. No.5�10344063 54folk Couhty C0mmissbon Ek 're arch �30� 19: ......................................day of ..................... ......., 19/. NotaryPublic, ...., �J m y ............. .................... . ............................... iv of ann[icant)