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Home My WebLink About7168-z FO~ NO. ~ TOWN 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) Ne 7168 Z Date ......................... .A~':I' -~-]: ....... -~0 ....... Permission is hereby granted to: (Rob2 Cuo~ao) to e ~4~ ~ .t,..a~...~a.~.n.t a.~.n.....6~.~.*.h.&.gh..*O.,.T~, .*-~e~te e-. {~*.~'} '*~e a~" ~a~'"~a" at premises located at .g/.~..l~,~'.v.:I.e~...~loa.~t...{.tl-.-..C[aoebt~.-'~..~ ............................................... ...................................................... ~oatt~l~ ...... ,~.. pursuant to application dated ............................ .~.;¢i.1,.....~0....., ,/19~ .... and approved by the, Building Inspector. Fee $:J.~. 6'~.g ............ TOWN OF SOUTHOLD BUILDING DEPARTMEN~ TOWN CLERK'S OFFICE~' SOUTHOLD, N. Y. Examined .... ~.~.:....(....~.. ......... , 19...~?.y Application No2../.......~ .............. Approved ..........v..:.., ........ ./....(?. ........ , 19..~..YPermit No. 7 / ~ f ............... ..................... Disapproved ............................................................................. y...? ......... .~ ........... ... APPLICATION FOR BUILDING ate .......................... ................. , INSTRUCTIONS a. This application must be completely filled in by typewriter or' in ihk and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according (o schedule. b. Plot plan showing location of iot and of buildings on premises, relatienship to adjoining premises or public streets areas, and giving a detailed description of layout ofproperty must be drawn ~n the diagram which is part of this application. c. The work covered by this application may not be commenced befor~ issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue ~ Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the e. No building shall be occupied or used in whole or in pa rt 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 iissuance 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 demo t on, as here n described. The applicant agrees to comply with all applicable laws, ordinances, buildi}~g code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary infpections. (S~gnatu[e of applicant, or name, if a corporation) ....... ............ (Address of applicant) '~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................ .~ .O~A~. Z~..~.6..Z. ~ ........................................................ , ........................................................................... Name of owner of premises ...~h,2.~....a..~ ........ m..a. ...... ;~...L.....~...~..~x. ~ ..................................................................... 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 w~)~h~ppp~se~x+il._k'b~,do~/.) .Mep~' No.: ...., ................................... Lo~::~a~.://~£~.:. ..... Street and Number .................................................................................................................................................. Municipality State existing use and occupancy of Rremises at~ intendeduse ~nd' occu~ancvof~r~osed construction: a. Exisiting use and occupancy ................................................................................................................................ b. Intended use and occupancy ............................................................................................................................... 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work ..............~..~l~. ~..~.. ................... (Description) O D ................................................ ............ Fee ........................................................................ .................. 4. Estimated Cost '~-'~--' ~ (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ 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, Jf 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 .................................... Rear ............................ Depth ........................ Height .................... Numbe~ of Stories ................................................. ~- ~--/ ~) ................................................................. / ,") ~' 9. Size of lot: Front ....... L..~...~.. ....................................... Rear ........ .'......'. .......................... Depth ....:..:...:...: ............... 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ ] 1. Zone or use distrfct in which premises are situated .................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded, . ........ .~ ................. Will excess fill be removed from premise, s: ( ) Yes ( ~' f'~ ne f r ' -" "' Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether exkting 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. / rL / 1/ STATE OF NEW 'L~D~,K~ x-*, / ~'r ~. c c COUNTY OF ....: ........................... ................................................................................................. being duly sworn, deposes and says that he is the applicom (Name of individual signing contract) above named. He is the ................................................................................................................................................................................. (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 there~,ith,,.,"'~ Sworn to befoF~me this ~ , '~ ............ ~..~]day of ........ ;. ..4 ..... ,Z .......... ~., 19~.... Notary P u b [)~;~ ;~ .~;;~ o u n t y u /' (Signature of applicant) JUDITH T. BOKEN ~uhlic, S,at~ of New York It~ '~' ~)344903 Suffolk County