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Home My WebLink About5162-z FORM NO. 2 TOWN OF SOUTHOLD BUILDING D E,.P.A. RT~EHT TOWN CLERK S OFFICE SOUTHOLD. N. Y. / / BUILDING PERMIT' CI"HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 5162 Z Permission is hereby granted to: ............... .l~aul.. ,?,J~.J'~,,ki. .............................. ............... ~.,.m,,.i~...~t~ ..................................... ............... ..J,~j...llar. be.~ ............ Il,Z,,. .................. to ... ezte~ ..~v. ~mm-.-~ · ~e~.~J~ll ...... ~lleb~e..heme-.v~..ml&te,~em) ........ Building Inspector. ;Fee $.....1.gz~.~ ........ pursuan~c to application doted ............................ .~-.-JJ&J~l~: ..... .e~....., 19.....~.9~ and appr~ by the ..... ~mroved ........................................ , 19 ........ Permit Ne ............... .~L..~.. Disapproved a/c .................. ~ ........ ....... (Building Impector) AFI~LIC, ATION FOR BUILDING FllU~I! Date ....................... k~.c]~.....1.2 ............... , 19.... 71 INSTRUCTIONS o. This application mu.t be completely filled in by typewriter or in ink and lubmitted in duplicate to the Building Impector. b. PI.at .plan _~x~ng I_.~zt_ ion of lot ..m~d of buildings on premises, relotiemhip to adjoining premilm oe _l~bli~ Itmets or areas, arm gnqng a detailed descripeion of layout of properly must be drawn on the diagram whlch il part of ~ ~q~flcation. c. The wo~ co~red by this application may not be commenced before issuance of Building Permit. d.. Upon. Qppraval of .this Qpplicatlon, the Building Impecto_r will issue a Building Permit to the applicant. Such permit ~hall ice Kept m the:pelmm~ available for inepectlon throughout the pragre~ of the work. e. No building ihall be occupied or used In whole or In port for any purpaee whatever until a Certificate of Occupancy shall have been granted by the Building Impactor. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pumuant to the ,Build!ng Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable I.owl, Ordina .nce~ or .~l~eulatdlk~ce, for the co~ltructlon of bullding~, oddltlorm ar al.rotations, or for removal or demolition, al herein delcrlbed. app cant agrees to comply with all applicable law~, ordinances, building code, housing code, and regulations. Paul Zebrewskt (Signature of applicant, or name, If a corporation) ~aaress or appdcont) State whether applicant Is owner, Imee, agent, architect, engineer, general contractor, electrician, plumber or builder. C~wn~-~' ( Contract Vendee) Name of owner of premises ...Pau2..JLe~.~s~ ................................................................................................................. If applicant il a corporate, signature of duly authorized officer. (Name and title 'of corporate officer) 1. Locatlon of land on which prppased work wlll be dona. MapNo.: .............. ~. ...................... LotNo.: ....... ~ ......... Street and Number .......... ,a~.... ~.[//~g~...~:£~r~...~,~a~ ...... ~. ......... a,~a:.e.L....[,L~,.~ .................................... Municipality 2. State existing use a.nd occupancy of premises and Intended use and occupancy of proposed comtructlon: a. Exlltlng use and occupancy ......... .~.~.~.P,~,~ ......................................................... b. Intended use and ~cu'~n-~~ one faml~2, dwell$.ng 3. Nature of work (check which applicable): New Building ,r.Z...X~c. ......... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost .......... '~G~.~0...~ ............................... Fee ...... .'J~J,J~) .... .. (to be paid on fRing this application) 5. If dwelling, number of dwelling units ........ ~..e. ............. 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 type of use ............................ 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ 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 ...~1+ ............................ Rear ...... ~>)4 ................. Depth ....1.2...J.~2 ...... Height .................... Number of Stories ....... Q~e ............... . ........... 9. Size al: lot: Front .......... ~.~..,.~+ ..... Rear ........... ~,~,~. ................. Depth ............ .~. ................. 10. Date of Purchase ........... .1.~1~/.1 .................................... Name of Former Owner ...... .~..qll~.~.~.),), ................................ !1. Zone or use district in which premises are situated ~ ' ; ' ............................ ~-~t .................. . ........ 12!. Does preposed construction violate any zoning law, ordinance or regulation.;> ............... ~ ........................................ )3. Name of Owner of premJses ..... ~.'~,tt,j~,../,~,b~ol~r._qj~L.,~:ldress ............ ~..~.~...'-.i~..~.~.(~.~ ........ Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ....... ~.8~lle ................................... 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' Y. OI~.K. tee COUNTY Of ..... ~1~. &'~].J~ ......... )' ~'~' .................................(Name of :'"':indl~'"~'e~slgning ap~ation)~ ........................ ~ing duly sworn, d~es and says t~t he is the appJicant above named. He is the ................................ 0~.....~o~gt ) ........ . .................... (~ntractor, ~t, co~rate officer, ~c.) of said owner or owners, and is duly authorized to pe~orm or have pe~o~ed the said work and to ~ke ~d file this application; that all statements contained in this application are tree to the ~st of his knowledge a~ belief; and that the work will be performed in the manner ~t fo~h in the application fil~ ~er~ith. Swam to before me ................. · ~.. day of ............ ~....~:~ ........... 19...~ · / ,' .& ........... ' .;:' . "' ............................. ~IzA~ETH ANN ~E~LLE ~TARY PUBLIC, ~d~e of ~ew York No, 52-8125850, Suffolk Co~ Term Expires March 30,