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Home My WebLink About7491-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDIHG PERMIT (THIS PEI:U~IT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7~91 Z Permission is hereby granted to: ........................................ ~,~,m~...~.~..~.....( ..~.....L..i.~.,......m.....~..~. ......... ................................ ~~. II,'Z, ............................. pursuant to application doted .......................... ~ ........... ~J,~....., 19...'~., and approved by the Building InspeCtor. Fee $.JI{~J.{~Q ........... LOT ~b MAP O~ -1 kl ~bSAU Po,NT- TOWN O~'SOL~T~IO~ID. ~.~', Disapproved a/c ............................................. ~ ._ %Ouilalng inspector) API~LICATION FOIt BUILDING PElt.MIT INSTRUCTIONS o. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Building Inspector, with 3 set~ of pk~s, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationsh~ to adjoining premises or public streets of areas, and giving a detailed description 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 applicant. 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 Building Permit pursuant to the B~uild!n.g. Zon,e O .rclinance of t. he Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinanc..es or Kegu~at~ons, tar 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. ....... ................. (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. ........................................... 0~rz~e~. ........................................................................................................................................... Name of owner of premises .....lv~.l..~OJll~a...~8~lt~,,l,~. ......................................................................... 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. Map No.: ~..~.~1.~.....~.~...?...~..O.~. ........ Lot No..~. .................... Street and Number ...~.~.~.l~Jl~.~..~.~.~..~.~....~...O..a.~....(~..~.~...(...[~...~....~..~...e.~..~..~.~. .................................. Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy .~.~f~..~....~...O..~ ......................................................... ~ ............................................... b. Intended use and occupancy ..e.~l~.;LQ..~13.~D,~ ......................................................................................... 3. Nature of work (check which applicable): New Building.......;EX;;I~.. Addition .................. Alteration ................. Repair Removal ......: ........... Demolition, .................. Other Work (Description) 4. Estimated Cost ............................... .~tOf~....u'~, ......... Fee ........ ~.0...(~. ...................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ....... ~. .................. Number of dwelling units on each floo~' ............................ 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 ......................... q-9. ...... Rear ........ .1.~). .............. Depth ..... .1.~. ............. Height .................... Number of Stories ....OD]I ......................................................................................................... 9. Size of lot.' Front ...6~ ............................................... Rear ............ 6~ ......................... Depth ......... 2~..+.. ............. 10~ Date of Purchase ........................................................ Name of Former Owner ....................................................... 11. Zone or use district in which premises are situated ...... t~.A.~.~...d;Ls.t ..................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ...... ~ ............................................ 13. Will lot be regraded ........~ .............. Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises ....J4~S.r.~/O~..~o~ ...... Address .....Cu.t,~I:XD~LQ. .....Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ....,..G~D.~I~'. ........................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly oil 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. see attache~ plan STATE OF NEW YORK, ~ c c COUNTY OF ....~£01~ .......... ~'~ .................... ~l~J'..~l~. ............... ~ ............................ being duly sworn, d~oses and soys t~t he is the applican~ (Name of i~ividual signing c~tm~ a~ove nam~. He is the . ~ ....... (Contractor, agar, cor~mte officer, etc.) of said owner or owners, and is duly aut~rized to peHorm or h~e performed the said .work a~ to ~ke and file this application; t~t all statements contained in this application are tree to the best of his kn~ledge and belief; and that the work will be performed in the manner set fo~h in the application filed the~h. Swam to ~fom me this .................. · 3. ............. , ........................... - ~/ ' ~_ , / (~ignamr~ of applicant) H~A~y PUBLIC, Sf*fe eI ~' No. 52'~522026 . Suffo;~ C Commiss/o~ Expire. March 30,°:':f~/ STLID[O .~0t~ F STUDIO Iq' X 15'