HomeMy WebLinkAbout5126-z FO~M NO. 2
TOWN O~ $O~TNOL~
BUILDING DEPARTMENT
TOWN CLE~R~('S OFFICE
SOUTHOLD, N. Y*
BUILDING PERMIT
crHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 5126 Z
Permission is hereby granted to:
............................................. Iiee..aM~fel~ ......... I~. .....................................................................
pursuant to application dated ...............: ........ ~...~.~& ...... .~. ............ , 19..~.~J., and approved by the
Building Inspector. (~il ~t, eh~ ~lt~:~l:~t;~Lelll V~L~L~ Z~lt(~l~ pe~t fFo~ ~ &ppu'l
J:ee $ ~#~J~. .............
....... .............
................ Bui,;~i;;;~"i;;;;~';;;;;'"'"~ .....
,'~ep,'o,,md ........................................ 0 ~9 ........ ,P~',df No. 5'/ (.' 7---
DilQpplqJlvld' Q/C ..~ ......... · .........
~IONS
~hoeil No bul~l beo~upled or mid In whole or In part fo~afly puqme wherever until a Cefflflmte of'~
(Signature of applicant, ~r nome, If a, eeqlemffon)
CAddPetl of appllmnt)
State wl~t~r eppll,"oflt Ii owner, i, agent, a~hltKt, engine!r, general contractor, elletrlelafl, plmdm, or builder,
.............. ,,,,],,~2 .,,..,,..,I~.~.W...~....&~)C~,~IGE. ....... ,... C,¢. J~'3~EA ~.~ O, J;i.,,.....,~,~.,~ ..~.;;~.T. TJ~ ...............................................
If appllcont Im o corporate, mljnoture of duly outhel'tJld officer.
(lqc~ ~ title 'of corporate
I. Location of I,,ncl on Which prcp4xJt ~ wilt be do~. Map No.S¢~t.,l~.~.~..~(..,l,~:.... lot No.: ........................
Street and Number ~;~...,~Z~,...~,L....~.,.~.~ ........ ~,.~2,~.i'~..~'~TZ~..2,v~.,.,:~.~.~.....:~'. ..........................................
2. State existing :uN a,nd accupancy of Pmmllm end Intended ume and occupancy of prapeled
b. Ifltlndld uN arM 'r: , ,', : ,~- · ~' ?~l'r,~ ," '
o~upan~,,_ ."~'U'F'~,. ~ O, ~.. ,L.,~ ~'.~,..~,, ~.., '~.~T..~R ~..1.C D..,~ A8,~9,~. ......... ,.;~ .......... '~L.~:- ..............
3. 'NaJum of work (check, w,hi,ch, ,a,pl~,llCC~ N~ Bultdi~.~, ............ ~A~lition .....Z..: .......... Alterati°n ....................
4. EstimatedRepa r ................. Cost . ~l.~,O.t..0.P...0..~..O..O.Rerfl°val .................. ..... ,,~l~m°llti°n=,. ............... ~"~" Otl~er~ Work (Descr be) ............................... ' "~1~" !"
(to be paid on filing this al~lication)
If dwelling, number of dwelling unit~ ........ J~,Qll ............. NUmber of dwelling glairs on.each floor ..... ,0..~..~.~ ...............
If garage, number of cam ..... .~...o...l~...t....~.o..~...u:..~..J.....~.. ,.?..X..~..~.~..~ !llt, Z,l~t,~
9. Size of lot: Front 3.68 ~'oo~ Rear same
................................................................ Depth ~ .................
10. Date of Purchase ....~f~,, ......................................... Name of Former Owner
1 !. Zone or use district in which premises am situated ..... ~B. II;L~II~,~,ld%~. .............................................................
12.
Does proposed construction violate any zoning,law, ordinance or regulation;? .~.~.......,. ....................~jj:~ .......... ~..,
13. Name of Owner of ~tsas ~c3~.~"~ ............. Address Ne#' S~'o~.k~ No
...................................... ...... Phon, NoS.~.g. .......
Name of Architect .;.::~:;;j~.~. ........................................ Addre~ ............................................ Phone No. Jr ..................
Name of Contracter Az~l~on® 0]:~I~1: . .. 01~t~o~o~1~®~
................................. ; ................. .~aaress ............................................ Phone No .....................
PLOT DIAGRAM'
.L~ca.~.e clearly and distinctly oil bull¢~ Whether existing or gralx~ed, ~ ljr~licate ~all letdxzck dimensions from
p, .m~m/, ?.~... ~ve ,street and,klock ' _or_deSC~rl ion ~_ to cle~ and' '"' ~t ' ~ .'""
~h.h., ,...,. .. .--.. ,.. -' .~~~ .~' ~Y,~D. to _ ~ -- .....nd Ind,¢ot.
................ ........ ........
0~..0~,, ~. .................... ..:.: ....... ~ ................. ,..~: ........ ~ ............................................
~.~oid ~r ~r.~; ~ is d~y ~r~:~ ~r~ or ~ ~,~/~
..... ~. ~ Of ...~ .............. , ,~. ~_~ ~. ~/._ '~
~, ,~_.,~ ,~ ~-'r .~.~ ..... ~.,:~
...~ ~,,~.,~~.. ~ ~-----r~.~,~i~.~ ..............................
6. If business, commercial or mixed occupancy~ sp?cLf~,n, ature and ~ ,of each t~pe of use ...,, ,.,~,,,m ....... ~..
D,mens,ons of same structure,~j~.elter~lrions or additions. Front .....~'B- J~. ........ Rear .-~.~.~..
Depth
8. Obinleosions of entire new construct on: Front .~:.~' ~.~.. ..............