The URL can be used to link to this page

Home My WebLink About7294-z?OWN O~ $OU?~O~D ! IIUILDING DEPARTMENy TOWN CLI-'RK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMIS]ES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7294 Z Permissi~ is hereby granted to: Ri~a~..~a~h~k~ ...................................... ..... ~ill~e~...~'¢a ......................................... pursuant to application dated ................... JF~b~..-.-9 .............. :. ...... , l~Zl......, and approved by the Building Inspector. Fee $..~'.,.00 .............. FOI~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE~ SOUTHOLD, N. Y. Examined '~'"~'~" 19'"~"~/ ,~, c~,/ ,-~ Applicotion No ................................ Approved /I .X ........ Perm tNa ........................ ... (Buildino Inspector) APPLICATION FOR BUILDING I~ERMIT Dote ....................... ~......~ ........... ]9...~.... iNSTRUCTiONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with $ set~ o{ plans, accurate plot plan to ~ale. Fee according ~o schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adioinin areas, and §iving a detailed description of layout ofproperty must be drawn ~n the dia0rom which is part of this application. c. The work covered by this application may not be commenced befor~ issuance of Buildin~ Permit. d. Upon approval of this application, the Buildin~ Inspector will issue ~ Buildin~ Permit to the applicant. Such permlt shall be kept on the premises available for inspection throughout the wor~ e. No buildin~ shall be occupied or used in whole or in part for any purpose whatever until shell hove been 0ranted by the Building Inspector. APPLICATION IS HFREB¥ MAD[ to the Building Deportment for theiissuance of a Buildinfl Permit pursuant to the Buildin~ Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lows, Ordinances or Re~ubtions, for the construction of buildinos, additions or alterations, or ~or removal or demolition, os herein described. The applicant agrees to comply with oll applicable laws, ordinances, build!no code, housino code, and re§ulations, and to admit authorixed inspectors on premises and in, building~ for necessar~ ir!$pections. (Signature of applicant, or name, if a corporation) ~t&ll~er Ave (Address of applicant) State whether applicant is owner, ~essee, agent, architect, engineer, gener!al c6~t:ractor, e}ectrician, plumber or builder. 0~er$ Richard ~tachnowski Name of owner of premises .................................. ~ ................................................. ~ ............................................................... 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 ............................................... Location of land on which proposed work will be done. Mop Nc.: ...~ .............................. Lot No...~ ............... Street and Number ~./.~:k~.Z`~.V~t~`/k~.~.~].~`~.~h~t`tb~...~1~*z~ ......................................................... Municipality State existing use and occupancy of premises and intended use an, occupancy of proposed construction: a. Exisiting use and occupancy ..... ~.e.~.~.J:...D:.~. ...................................................................................................... b. Intended use and occupancy ........ .s..~..~...e...~$..t¢..~....~'.~.~ .......... ,~ .......................................................................... Nature of work (check which applicable): New Building .................. Addition .................. Alteration ............. "...~-- Repair .................. Removal .................. Demolition .................... Other Work ..... . .1'.e.13..0..e. ............................... . .... (Description) 4. Estimated Cost ...... ~...~.~...~. ................................... Fee ...1..~.?..0..0.. ........................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ......... g.~...e. ............ Number of dwellfng 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 .................................... Rear ............................ 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 ...... !!~.~!...¢t,;Ls.~ ............................................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ....... l'~q ............................................ 13. V/ill lot be regraded ....... ~g. ................ Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises ....... ~.$..q~.~:~.~..~[~,g~;~f~.~.~l~t. Address ....... .¢11Zli~b.¢}~,,11~..., Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor $~rne ............................................................ 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 corner lot. 7'-0 7'/:/Z STATE OF NEW YflRK~ ,, lc c CO U~,~TY¥/~ /7 .~ ~,~_ b' - 7/OE ....... ~.9-~ ........ ~'~ ...... '~~....~.~~ ........... being duly sworn, deposes and says that he is the applicam (Name of individual signing contract) above named. 0~e~ 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 fo~h in the application filed therewith. Sworn to before me this ........ ........ .............. .............. , Nota,~ Public,. ......... ~~~ ...... CounW ...~.C.~~~ ........................ (Signature of applicant) ~ ~UI(OWSKI No 524399485 Surf ,,-- Torm Ax~ires March 30,