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Home My WebLink About3531-z FOEM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHO/D, N. Y. BUILDING PERMIT. (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°, 3531 z Permission is hereby granted to:r .i:.....'.:.:~.'.~.*.~..~.~....~ ............ ..~ ......... ~.....'/:.~..~ ............................ ............. pursuant tO dpplic~3t on dated,.....,, ................. ,:.~J~,tl~..:..i':.....~ ....... ,. 19~.,{~,, and approved by the< Buildin~ Inspector, Building Inspector FORi~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ............. Appraved ..................... ............... , Permit No. .... Application No...~....~..¢.../. .............. APPLICATION FOR BUILDING PERMIT Date ................................. , ,~..g~....e.......~...0..... i.., 19.~Z ...... 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 a detailed description of layout of property 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 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. 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 all applicable laws, ordinances, building code and regulations. Stanley Droskoski (Signature of applicant, or name, if a corporation) Orient (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................................................ ,0. ................................................................................................. Name of owner of premises ....S...~.f~.rl....]:..e.Z...D..r.°...s..k..°..~.k.'.~ ........................................................................................................ If appllcant 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.: ....~..'.X..~.. ............................. Lot No.?..~..-.x. .................. Street and Number Main }toad Orient Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Existing use and occupancy ....... .f..a...r..~...1..a..~.o...r.....h..o..l}.s..i..r.t..g. ................................................................................. b. Intended use and occupancy sarae with an additioB. XXXX 3. Nat ire of work (check which applicable): New Building .................. Addition .................. Alteration Re~c ~ir .................. Removal .................. Demolition .................. Other Work (Describe) 4. Esti, hated Cost ..~!.).0.......?../...~. ....................................... Fee ...~:..0...0. ........... (to be paid on filing this application) 5. If cjwelling, number of dwelling units ............................ Number of dwelling units on each floor If ]rage, number of cars 6. If usiness, commercial or mixed occupancy, specify nature and extent of each type of use 7. Di ensions of existing structures, if any: Front ............................ Rear ................................ Depth Heir]hr ........................ Number of Stories Din:Jensions of same structure with alterations or additions: Front .................................... Rear Dep;th ................................ Height ............................ Number of Stories ................................ 8. Din~ensions of entire new construction: Front ...... ~ ........................... Rear ....... 8 ................... Depth ...... .2:..~ ....... Heibht .................... Number of Stories ..... .o..zg...e. .................................................................................................... 9. Size-of lot: Front ...... .2.]~...~...O.P.~r .................................... Depth J 10. Da~e of Purchase ........................................................ Name of Former Owner 1 I.. Zor~e or use district in which premises are situated ..... ..A....~.~.~ ............. 12. Do~s proposed construction violate any zoning law, ordinance or regulation? ~O 13. Na~e of Owner of premises ...~.~.~:.e.~....~..?..O...~..~..°...S..~ddress .............. ..C)..r..i..9..~...~. ............... Phone No. Na~e of Architect ...................................................... Address ............................................ Phone No. Na~e/ of Contractor ..~..:...[2.~..b..o...r. ................................ Address ............................................ Phone No. PLOT DIAGRAM Locat;e clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions property I nas. Give street and block number or description according to deed, and show street names and whether nCerior or corner lot. S'TATE O~ NEW YORK, COUNTY OF ..... ~.'O,~':q~L~ .......... ,f · ' ,, Stanley Droskosk~ Sr ................................................................................................ being duly sworn, deposes and says that he is the appli¢ (Name of individual signing application) above na~qed. He is the Owner builder (Contractor, agent, corporate officer, etc.) of said o~mer or owners, and is duly authorized to perform or have performed the said work and to make end this appli,:ation; that all statements contained in this application are true to the best of his knowledge and belief; that the ~ ark will be performed in the manner set forth in the application filed therewith. Sworn to l.efore me this ................ i..~.O, day of ............................. ,~..g~......, 19...~.~.. '~ Notary P~ blic, ...~...~~...~.;.. . County ignature of applicant) ~,~ARION A REGENT NOTARY PUBLIC, S~ate of New York(/' J~o, 52-3233120 Suffolk County ~Term [xpires ~rch 30, 19~.~'~