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Home My WebLink About7345-z FO]~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 73 5 Z Date ................................ ~.LU~.....20....., 19.~t.+.,. Permission is hereby granted to: J~h~.,~mL~h ....... &/C...CJae~.r...~k~.ara ...... ............... ..a..V.~ ~).:..o..~ .u.e. ........................................... to ....~..~...~.~x~...~...~.~.. ~e~.~z~ ............................................................ at premises located at .~.9.~.~..~.~ ................................................................................................... ]:ee onic ~x .Y. ~s~e~ $o e~p~ce$~o~ defe~ ............................ J.~...,.~ ........ , ~9..~., end opM~ov~ bF She Fee $'1. ~.*.OO ............ FORM NO. 1 TOWN OF SOUTNOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, ~ ~ ~ ~r ~ ~ ..,. N. ¥. Examined ............ ~., 19..~!..~.. Application No ............................. Approved ........I/. ........... ~.L~ ....... ~, 19.?...~ Permit No .................................... D,sopproved a/c .......... .................. .............. (Building Inspector) .......... APPLICATION FOR BUILDING PERMIT Date June 2.0. ,, lc. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale~ Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relat onship to adjoining premises or public streets o~ areas, and giving a detailed description of layout ofproperty 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 work. shalle' haveN° buildingbeen grantedShall bybe the°CCupiedBuilding°r usedlnspector.in whole or in part for any purpose whatever until a Certificate of Occupancy 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, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. John ~rush (Signature of applicant, or name, if a corporation) ...... ..T...r...a. ck ~ve CutohoEue .................. ............................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......................................................................................................... Name of owner of premises .C..i.~p~..t.~.~. ~..k~.j~ra if applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: ............ ~ ....................... Lot No..~ .................. Street and Number ..~:,r~]L~.s..~[oa, d ......... ..~.e.(~"t;[~, .............................................................................................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy b. Intended use and occupancy ........... j~.~.~.e:...)Z~.}J...~..~.~.~..J:.~..~.O.~ .................................................................. 3. Nature of work (check which applicable): New Building.. ................. Addition x-x'XX ....... Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ................................................ .... (Description) 4. Estimated Cost .............. ~.0O...~. ................................. Fee ..~'.~'.~.(~ ............................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ........ .O..~.?. .............. 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 ............ L~' .................. Rear ...,~. ................... Depth ..... .1~ .............. Height .................... Number of Stories .............~:~l'A8 ................................................................................................. 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..... .~!A!!.....DJ. sI.~ .......................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........ X1Q ........................................... 13. Will lot be regraded .....llO. ................. Will excess fill be removed from premises: ( ) Yes ( ) No 14. Nome of Owner of premises ...... O~esl.te~...~l~al'& ............ Address ....J?.~13.gl:r~gJ ........... Phone No ....................... Nome of Architect .............................................................. Address ................................ Phone No ....................... Nome of Contractor ....~......~.~fl~ .................................... Address ...0..~...t..o...h..o.~...e. ......... 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 corner lot. I STATE OF NEW, YORK,, l c ¢ COUNTY OF ..~..U$..:.$'g...J~... ............. f~'~ ........................... ,AT,o~g...~'~.~ ............................................. being duly sworn, deposes and says that he is the applicon~ (Name of individual signing contract) above named. He is the Builde~ (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 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. Sworn to before me this ,' . . // /7/" ................. day of .................. ................ , ?' ,,./, -- A,' . ., Notary Public,. ................................................... Co..ty ...... / (Signoture of opplic~nt)