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Home My WebLink About5127-zTOWN 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) No. 5127 Z Permission is hereby granted to: to ............ ~s~t.~ ....................................................................................................................... ot p~ ~,~o~ed ot .... ~..~s..~lL ~..A~Jrl.~...l~...l~..~...I~v~#~...l~.~ ............. .................................................. ~;1~ ....... ~,~ ......................................................................... pursuc~n~ to application dated .......................... ~lk~l~ ......... ~l~ ........... , 19...~, and approved by the Building Inspector. SUFFOLK COUNTY DEPART]~ENT 0F HEALTH ........ .o. ~he )osed erraa~.ements for sewage disposal and water s%pply, ~ez'e 8p~(,v~l rm t}-,~ zh,oVO r]~,t,~ N-t a,,ont~rtsnce w~h ~l~ms ~nd a~ ~11 c. at~ou on fl] e zn the o~z'ice Ol' thn ~,'Jl'fol]q C01111%[/Department ~of Health~ th~s endorsement a-pp~ars :n ~l:e offzce of ~,/~,.~ ~.~ ;This amproval does no ~ include ~ ~ructural featureo mtd is ~ranted {on condztion that the proposed facilitzes ara installed ia con- ~foz~ty with these pl~s~ Chief of General Engineering Services NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. 19.?.../... ^pproved ........................................ , 19 ........ Permit No. ~ / ) ? /~ Disapproved a/c ............................................................ Apphoat ion No APPLICATION FOR BUILDING PERJ~IT Dote ............................... .~..~.~,~.~'~...~.~.., 19.~/.JJ.... INSTRUCTIONS a Th,s application must be completely filled in by typewriter or in ink and submitted in ~,'phcate to lhe Buddin Inspector. b. Plot plan showing Iocat,on of lot and of bmldings on premises, relahonship to adloining prem,ses or public streets c areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this applicatior c, The work covered by this apphcation may not be commenced before ,ssuance of Building Permit d. Upon approval of th,s applicat,on, the Building Inspector will ,ssue a Budd,ng Permit to the apphcant. Such perm 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 Occupanc shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the ,ssuance of a Buiid,ng Permit pursuant to th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, cnd other apphc~ble Laws, Ordinances c Regulations, for the construchon of buildings, additions or alterations, or for removal or demoht,on, as herein descr,bm The applicant agrees to comply with all applicable laws, ordinances, budd,ng code, housing code, and regulations ... Lawrence Lisso ~r (S~gnature cf apphcant, or name, ,f a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde~ .............................................. ~me~. .... buAl~e~ ......................... Nome of owner of premises .... ~i~.JiI1,Gg...~,~SS.O..~T~ ..................................................................................... If applicant is a corporate, signature of duly author,zed officer. (Name and title 'of corporate officer) 1 Location of land on which proposed work will be done Map No ...... ]CX~ ................. Lot No .... ~ ........ Street and Number ........ .~j'~..~.~a~...&.At~.l~e~,~...~.~l~TL..~..~..JbO~.t~r...J~ ....... ~tl,t~g,,'L~J ....... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construct,on' a. Existing use and occupancy ..... ~'~.i~. d.~e.Z.t.~l~...&-..Ba-~ ................................................................... b Intended use and accupanc, ---Q~)~'~e~,~)l~- &-.~,c~eli. t~-to~..%o..etwe-]J:~.i.t~g---tt-e>~--,e~¢~¢ ....... 3. Nature of work (check which applicable): New Budding .................. Addition ......~ ...... Alteration .. ~ ..... Repair .................. Removal .................. Demohtion .................. Other Work (Describe) .................................. 4 Estimated Cost ,t, Fee ..... ~t~ (Ott~ ......... ~i ........... ,';i~' ........................... .................... 'TO'fO00"_ .................... (o be p 'd on f'.' g th~s apphcati~i .......... 5. If dwelling, number of dwelhng units .... l::l~t .............. Number of dwelling units on each floor ............................ If garage, number of cars ............................................................................................................................................. 6 If business, commeroal or mixed occupancy, specify nature and extent of each type of use ..... 7 Dimensions of existing structures, if any: Front ...... ~.~ ................ Rear ........... ~ ................ Depth .....,~. .......... Hemght ........................ Number of Stories ...l~r. ........................................................................................................ D~mensions of same structure with alterat,ons or additions: Front ....................................Rear ........................... Depth ................................ Height ............................ Number of Stories ............................. 8 Dimensions of entire new construction: Front ........... ~ ...................... Rear ....... ~ .................. Depth ..~,JD ............... Height .................... Number of Stories ............~ ................................................................................... 9. Size of lot: Front ........ ~.,~.'1'. ......... Rear ...... 2~6 ..................... Depth .......... ~..1.~. ........... 10 Date of Purchase ........................................................ Name of Former Owner ..... ~..,....~.g.l~.:k~ .............................. 11. Zone or use district in whmch premises are situated ...... ..".]B.."...cllS.~ ........................................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation? ........ 1~ ............................................. i3. Name of Owner of premises .~..'.~..~. ......................Address ...~.~..~..t¢..~...O.~.~. .................... Phone No ..................... Name of Architect ...................................................... Address ........................................... Phone No ................... Name of Contractor ...~likl~ ....................................... Address ........ ~.Qllt~g.],.~.. ................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly oll buddings, whether existing or proposed, and md~cote oil set-back dimensions from property lines. Give street and block number or descript,on according to deed, and show street names and indicate ~hether interior or corner Jot. See attached pla~ & Survey STATE OF NEW YORK, COUNTY OF .i~.~¢~.~],I~ ............. ~'~' ........................................ ~W~1~1~...~$$~ ..................... being duly sworn, deposes and soys that he is the apphcant (Name of individual s~gning opphcation) above homed. He is the .................................. ~, ..... ~,~.]ka~'. ................................................................................. (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 all statements contained in th~s application are true to the best of his knowledge and belief; and that the work wilt be performed in the manner set forth m the application filed therewith Swam to before me this ................. 26.. . of .............. J ~ .... 19..~.1. . ..... ........................ Notor'! PubJic~U~..~.~Cou,~ty~ (Signature of applicant~/ 6/ ~UZ^B~H ~,~.V!~L~', . - ROTAI~Y PUBLIC State o!. NZ/~ - W,c, 52-8125850, SUffolk Coq~t~ Term [xplres March 30,