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Home My WebLink About1369-z FOI~[ NO. 2 TOWH OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS P. ERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 1369 Z Date ................. ~la~'oh'"'~'l .................... 19.~.'1.. Permission is hereby granted to: 0se~,..-Get~14.m .................................................. ............. }~a'in'"8~ .................................................. ....................... G~ een-~o~..t ~......~L.¥., .................... to '"t',~rve"'an"~i'stTnE"dwe:~i~g"'tc"thTs'"ne~"'to~a~'ion .......................................... at premises located at , ~ '"Loq;s"~8"'&'"80;"'"'Ore'~n~or't"~rivin~"'Pa~ ................................ ................................................ .~/S..--..Ft-z-n-b --~ .t - ~¢.t en~i~rt. ........................................................ .......................................................... Gr e~n~'~r~ ~" "'~;' ~; ................................................................. pursuan~ to application dated ................................ -Mareh..-..~.O .......... 196t...., and approved by the Building Inspector Fee $' '10'~ O0' .......... ~u,,a,ng ,,spec~or ~, FORM NO, ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN C,ERK'S OmCE SOUT.OLD, N. ¥. Examined ........................................ 1 ~ ........ Approved .................. .~ ................... 1 ~ ........ Permit No ............................... ........................ ~}'i'l~'i~¢"i~}¢}~';g~ ................................. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to odioining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this location. c. The w~rk 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 progress of 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. APPLIC,~TION IF HEREBY MADE to the Building Department for the issuanc.e of o Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinonces or Regulations, for the construction of buildings, additions or a Iterations, or for removal or demolition, as herein described. The applicant agrees to comply with all appllcoble laws, ordinances and regulations. .... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises......O.~O~,1~...{~:l,~iFl ........................................................... : ...................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) :~/~ ~78 & 80 ~z'een~'~ ~ I~az-k 1. Location of land on which proposed work will be done. Map No: ~ ....... Lot No' .... :I:~I~"'D6'~'~;~ I~.~l'~i ~,~].~'~ ',~ .............. Street and Number ............................................................................ .~...~.~,..~.~.~...~....?.....~..~...~...~ ............................... Municipality 2. State existing use and occupancy of pr. emises and intended use and occupancy of proposed construction: a. Existing use and occupancy ......... ..~..~..~..~.~...~..~...~..~. ...................................................................................................... b. Intended use and occupancy.......~..e..~..~f~P~l~. .............................................. ~ ..................................................... 3. Nature of work (check which applicable): New Building .................... Addition ....................Alteration .................... R,epair ..............'......Removal .... ..~.. ............ Demolition ....................Other Work (Describe) .................... 41 Estimated ~*' Cost ............ ~J[~ .g ........................................ Fee ............i ~'~t~01~ ~]'i'~]' '~J' ']f'iTi'~'~' '~i~' '~]'l~'~'l'i'~ ~ii~ ~i ................... 5. If dwelling, number of dwelling units ................................ Number of dwelling units on each floor ............................ If garage, number of cars ............................................................................................................................................ 6~'I I[ 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 alteratioas or additions: Front ................................ Rear ................................ Depth .............................. Height .............................. Number of Stories ................................ 8. Dimensions of entire new construction: Front ............................ Rear ............................Depth ............................ Height ............................ Number of Stories ............................ Size of lot: Front ............................ Rear ............................Depth ............................ Date of Purchase ........................................................Name of Former Owner ........................................................ Zone oF use district in which premises are situated ................ ~Jt~j~,~[il~j~j~l~ ..................................................... Does proposed constrwction violate any zoning law, ordinance or regulation? ....... ~ ....................................... Name of Owner of premises ........................................ Address ............................................ Phone NO ..................... Name of Architect ........................................................ Address ............................................ Phone NO ..................... Name of Contractor .................................................... Address ............................................ Phone NO ..................... 10. 11. 12. 13. PLOT DIAGRAM Locate clearly, and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Gi~;b street and block numbers or description according to deed, and show street names and indicate whether interior or 'corner lot. ,1 COUNTY OF ...(.Z...'.~..~J.:...I,.....)J~"-' ............................ .~. .................................... ~ ..... being (Name of individual signing application) y ~ST ' duly sworn, deposes and says that he is the applicant above named. He is the ............................................................................................................................................................. (Contractor, agent, corlborate 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 applicati,o~?~'h~t all stotement~s_c~_ntained in this application are true to the best of his knowledge and belief; and that th~(work/will be perf,,rind inmt'l~e m,anne~ set forth in the a~tion filed t~er~ith. Sworn to be~re~e this ),~J~ ~ x~ t ~ ~jVw~ ..... m Jtesiding in ~f~I( NoCa~ ~u~l Jc~ .................. ~oun~ks. ~o. 5 ~ - ~ 8 ] (~ 4 o o Commission Expires }~]~rch