The URL can be used to link to this page

Home My WebLink About2737-z FOltM NO, 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF: THE WORK AUTHORIZED) N? 2737 z rate ...................................... ~ ......... 29, 19.65.. Permission is hereby granted to: .... Ada~..[....Do~osk~ ....................................... ......... aay..Awe ..................................................... ................... C.utahogae, ..... ~h sr, ...................... to ...... Bu,tXd... new...one.. ,~matZ~.. duel;l&ng ................................................................................. at premises located at ...... ~.~.~.,,,,l~aF,,A.v.e ........................................................................................... ....................................................... Cut=hogu~t.....H.X ....................................................................... pursuant to application dated ................................ ApP.:II.....90. ......19.~.~.., and approved by the Building Inspector NO~EI Lot 8pproved b~r l~L/Appei~l Fee $"1'O~ (')O .......... Building InSpector / TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .................... , 19 ........ Application No, ~L ~ ~ ] Approved .............. ~ ........................ , .......-_. ', ................................ ...... .......... .......................................... .................. ................................ APPLICATION FOR BUILDING FERMIT 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 adjoining premises or public streets or areas, and giving o detailed description of layout of propertymust 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 progress of the work. e. No building shall be occupied or used in whole or in part i~or 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, 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 oil applicable laws, ordinances, building code and regulations. Adam ¥. Dorosk! (Signature of applicant, or name, if a corporation) (Address of aplSlicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build'er. Name of owner of premises ....Ada~..~.o...~.~lk~, ............................................................. . ............................................... If applicant is a corporate, signature of duly authorized officer. ~ (Nome and title of corporate officer) i 1. Location of land on which proposed work will be done. Map No: ...... ~ ................ ;..; ....... Lot No: ...~;~ ...... Street and Number .~....~.*.&~.~.....~t~la~l)~,t~1~y..~l~.~..~ ............................... ~.-..; ........................................ Municipality 2. State existing use and occupancy of premises and intended use and occupancy' of! proposed construction: a. Existing use and occupancy ..... .~.l&~l~l~t,...~l~t~ ..................................................... ~ ............................................. b. Intended use and occupancy ........ ~.~..([¥~,:l~t~ ............................. !~ ........ ; ................................... 3. Nature of work (check which applicable): New Building ...~ ..... Addition .................. Alteration .................. ~, Repair .................... Removal .................... Demolition .................... Other Work (Describe) ...................................... '~' ~l~Estimated Cost ...~.~.,,..~.~.~.....~. ............................. Fee "II"~,~OD ...................................................................... : ~ro De paid on filing this ppplication) 5. If dwelling, number of dwelling units ...... ~II .............. 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 tl/pe of use ................................ 7. Dimensions of existing structures, if any: Front ..........................Reur .......................... 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 ....... 2....~.~. .......... Depth .....~.0 .................. Height ............................ Number of Stories ...O....1~.. .................. 9.'I/~ Size of lot: Front ............ ..,~.. .......... Rear ........... ~. ............ Depth ......... ~"'~O...~.i~ ...... 10. Date of Purchase ........................................................ Name of Former Owner ...... =~'~...~...O..?..~.h...T..:~.~..Z..~...?.~. ] ]. Zone or use district in which premises are situated iiA;~..~.~.~i~ ............ ; ................................................ 12.~ Does proposed construction violate any zoning law, ordinance or regulation? ....... I1~:..~..~..~ .............................. 13. Name of Owner of premises ~l~..~...~lliE~...Address ..... ~ ................. Phone No ..................... Name of Architect ...................................................... Address ............................................. Phone No ..................... : Name 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 numbers or description according to deed, and show street names and indicate whether interior or corner lot F/' STATE OF NEW YORK, ~, COUNTY OF ~"¢~1~ ............... ~ S.S. .................. ~lllI..~,...])ll.~l~l ........................................... being duly sworn, deposes and says that he is the applicant (Name of indl-vrcFu~l-~l'~ning application) above named. He is the ............. ~llltl~..=,..ll~i~.].~ ................................................................. ; ..................................... (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 oil 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. Sworn to before me this ............ · 7-. ...... ................ )q,~ ~ /C, ¥~r/ ~ ~/ r: ::~.~.,.xc.~/.~-.~. ................ ,~./.....'~.~ ........................ .~-......~ ....... Notary Publ'c,'..f.l..f~..~.....(~'. ...... ~:~..0...~ ~ant~;::. si~....: -'~c]n~te of-a~p~ ,. 1,~? .