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Home My WebLink About7242-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) N? 72 2 Z Date ................... fl&~, ......... ~ ................. , 19r~... Permission is hereby granted to: .~,,,...~ll~t,~...~..t,/,1,~'~ ......................................... ............. O~.l.~n~ ..................................................... at pmmi.~ lec~:l at l~.~..}l&~'...~.~,~,~:~ ............................................................ ........................... ................................................ ~te~t ....... I~.~[.. ................................................................................ pursuant to application dated .......... ~ ................ ~a~l' ............ 8, ...... ,,~9.[ ...... , and approved by the Building Inspector. ~OT~ Ne~d ~ez3r~ite~s cer~. for C/O Fee ~11,.~.0~ ............. Building Inspector Disapproved o/c ................... ..~.:..~ .......................... ~ ............. . ................................................................... .............. .... .............. (B~ildlng ins~ctor) *PPLICATK)N FOR lUlI. DIH; PERMIT Date ....................... ...~.,Z ....... ,8.. ....... , 19.2~......,~ 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. Plat plan showing location Of lot and of buildings on premises, relationship to'adjoining premises or public streets or areas, and giving a detailed d_~__ription of layout ofpraperty 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 ppplicanC Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole Or in part 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 issuance of a Buildi.ng Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and otherapphcable Law~, Ordinanc.? or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein descr,bed. The applicant agrees to Comply with oil applicable laws, ordinances, building code, hdbsing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary ir'mpactions. (Signature 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. ............................................... ,~7~.,~.__~__~ ....................................................................................................................................... Name of owner of premises ..:~.~l.~...~.~.p....~..l~;~'.p. ........................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... ov21el· Plumber's License No ................................................. Electrician's License No ..... ~;l,34~1~,~ ....................... Other Trade's License No ............................................... Location of land on which proposed work will be done. Map No.: ......... ~ .......................... Lot No.......:~.. ................ W ]i~. eel O~;~flT~ ...... Street and Number .... r./..~. ........ ..1~...~...~.~. ................................................................................................ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy .....CT.~.g,l~3,~l~ ......................................................................................................... b. Intended use and occupancy ........... / 3. Nature of work (check which applicable): New Buit~ltag .................. Addition .................. Alteration .................. Repair .................. Removal .................. DemOlition .................... Other Work ...a)..~.~.~...~)~..O..O...~...~...~ .~..~.~... (Description) 4. Estimated Cost .................... ~7.~'0..~ ........................... Fee ...1.~..e.~ ............................................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ........ .1 .................. Number of dwelling units oneoch floor ............................ If garage, number of cars ....................................... i.....:. ................................................. ... ........................................... 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 ........... 2a..cl~L~.~.~'.t,. I~bll~ .......................... Depth ........................ Height .................... Number of Stories ...................................................................................................................... 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 .......... .~,~?....~I~.~ ....................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ...... ~). ............................................ 13. Will lot be regraded . ....... ~.t~q. ............ Will excess fill be removed from premises: ( ) yes (:lC) No 14. Name of Owner of premises .~.~..JlI~:Lt:,e..~ci.~:L~e ............ Address ......~g~.:l:..e..~ ........... Phone No...~..,~,i ............ Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor s~me ............................................................ 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 coraer lot. STATE OF NEW YORK. ~. COUNTY OF ...... ~1~1)1 lr ........ ~'3'3 ................................................................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contracf) above named. He is the ..................................... .~.~.~ ............................................................................................................ .................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly a~horized to perform or have performed the said work and to make and file this application; that all statements contoined 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. Swam to before me this ...................... ........... , Notary Public .~-/~.....~...,~....~nty ....~k~ ..~ ...~..:..J~........~:~,~.. ......................................... j{Signature of applicant) JUDITH T. BOKEN Notary Public, Stale of New York No. 52.0344963 Suffolk Coun[~//I~ Commission Expires March 30, 19-l-/I}