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Home My WebLink About4076-z FOR~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOI. D, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 076 Z Permission is hereby granted to: ...ga~l ..gl~ t,~a~ea.. &..l~l,te ................... to ..]m,g~..~,.~A&t~,taa..m~.a~ .~J,~t~..c1~el~,~ .................................................... at premises located at ....~J~,...~.J~.....~lJ~J~JJ..J~ ......................................................... ............................................. ~.~.~z..!gl~e ....... .~mJ~J~& ........................................................... pursuan¢ to application dated ................................. J~tt~ .......... 6 ........ , 19..~, and approved by the Building Inspector. Fee $...~..e....O~.... ........... Building Inspector Al)proved ................ : ....... '; ............... , 10 ........ Permit No ..... , ............. D. r ed o,c .............. , ............................................. . ."%'t · ............................................................ ; .......... ................. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS th~ Bui Idin~~, o. This application must be completely filled in by typewriter or in ink and submitted in duplicate to Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or pu. blic streets or areos~ and giving a detailed description of layout of property must be drawn on the diagram which is port of c. The work covered by this application may n6t 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 shell have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for. the issuance of a Buildi.ng Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable 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. (Signature of applicant, or name, if a corporation) ......... ... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................. .~....W....~?...¢ .~. ........................................................................................................................................................... Name of owner of premises..~..q..m..?.....~......~..~¢...6~..'~- Z C.~.~.e3r/,* .,e,$,.--e If applicant is a corporate, signature of duly authorized officer. ' .................................................... ~' (Name and title of cOrporate officer) 1. Location of land On which proposed work will be done. Map No..'~...~..~.~.....~..~..e....~....?.~...~...... Lot No.: ..!../.'"~" .............. Street and Number ...~.~.....~...'~....~..~..~.. ........................................ i ........... .~.~.~.....~.P.....~... ............................... 7~/-- ~_m ~l~ Municil:x]llty . 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... ~.¢..~. ........... .-a.~ .......................................................... ~./~'.. ............................. b. Intended use and occupancy .............. ..~...~..,.'~..~ ........... 3. Nature of work (check which applicable): New B~ilding. ................. Addition ......../.... ..... Alteration ,,.,.;;,.i ........ Repair .................. Removal .................. Demolition ................. .o~her Work (Describe) ..... ; .................................. 4.' Estimated Cost ..... ~..x~.~...O.. .................... .... Fee ....~ ..~ ........................................................................ (tO be paid on filing this atoplication) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor: ......... L ................. 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 ........ i~.. ......................... . Dimensions of same structure with alteratioqs or additions: Front $1 ~ Rear . 5"1 · Depth ....... ~....~. ................. Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front . .............. ~. ....... , ....... Rear ............................ Depth .~..~. .................. Height .....~...~ ......... Number of Stories I 9. Size of lot: Front . [ ~ ~ ~ .................. .~ ..... Rear ........ /. ............... Depth .....~....~...~.. ................ 10. Date of Purchase ............~...-...~....O. .............................. 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? ...... ..~..~. ..................................... ~ ......... 13. Name of Owner of premises ~.~..~....:....~..~.~..~..~'.~.e...~...~.~r~ress /~/...~.ff.~....Y...~...~.. ................. 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 number or description according to deed, and show street names and indicate whether interior or comer lot. STATE OF NEW ~ e ~t' ~,, ................................--~ ~ 'Y-" [,.,e~r~....7...... ~.._........i....................... ...... being duiy sworn, deposes and soys that he is the opplicant (Name of individual signing application~ ~ ~ /~/~ ~' above named. He ,s' t~ ...--'---'--"- ~..~ ......................... - ~--,'-~-~ ~..~. ..................................................... (Contractor, agent, corporate officer, etc.) -e~,-se~l~owner~ ~.--;~ and is duly authorized to perform or have performed the said work and to m~ke and file this application; that all 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. Swam to bef~ce me this ~ -- ~ :....: ...... ....... ............ .............. ~lotary ~ubhc ~ ~ Coun MARIO~I A. REGENT NOTARY PUBLIC, State of New York No. 52-3233]20 Suffolk Count~. ~ Term Expires March 30, 19.~ 7'