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Home My WebLink About8769-z FOF. M NO. 2 TOW~ OF $OUT~OLD BUILDING DEPARTMENT TOWN GLERK'S OFFICE SOUTHOLD, N'. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ]Lq'? 8769 Z Date .......................... ~Zt_q.~F. ....... 3J~ ......... 19.-.26 Permission is hereby granted to: ............ g~l~s..~o~a~ .............................. ......... ~t~i~k ................................................ to Build an addition on existing dwelling at premises located at .... .~. ~..~.1~p~J~,~,l~...1~.gl~ ................................................................................... ~attituek ' · ................ ' ................................................................................................. ;" ..................... '~ ...................... , %'- ~ 2' ~ ........................................ : ...................................... %~ pursuant to application doted ................... ~.~. .......~. .............. , ]9~.~;~.,,~nd approv~ by the· ~=' Building lnsp~tor. . .~_ ~ ,.;k,.5~.:~~ ......................... . Bui!~ding Inspect& [ I J Approved TOWN OF ~OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE Sou'rHOLD, N. Y. Disapproved a/c .... ~ APPLICATION FOR BUILDING PERMIT , Date .............. ': ...... ~ ....... , 19.~.(~ ...... .. v' INSTRUCTIONS - i~' i~ntr licate~t a. This application must be completely filled in by typewriter or in ink and sub~ ip e Building Inspector, With 3 sets of plans, accurate plat plan to scale. Fee according to schedule. -", ~ ~ b. Plot plan showing location of fat and of buJJdings on premises, relationship to adjeining premises or public streets or areas, and giving a detailed description of layout ofproparty must be drawn on the diagrc~m 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 Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinqnces 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 necessa~/~ · . ........ ;~ ........... ;;?;~ ............. :7'"~ ........ ~ ' ~gnarure or appucant, or name, ~r a corporanon~ (Address of applicant) .. State whether applicant is owner, ~essee, agent, architect, engineer, general contractor, electrician, plumber or builder. .............................. ...................................................................................................................................... Nome of owner of premises If applicant is a corporate, signature of duly authorized o~fiCe?. / (Name and title of corporate officer) Builder's License No ........ ; ............................................ Plumber's License No ........... ~, .................................... Electrician's License No .... '. ........................................ Other Trode's License No ....... :'......: ................................ Location of land on which proposed work will be done. Map No.: .../..~..~....~../..../.....~.. .......... Lot No..~..0.. ...... ~..'.~..... Street and Number ..... ~/,~..~....'~.........~...~.~;..'7~....~..~/./~.~-,~../.~........~....D....../~..l~'~..t..'/~..~.~..~ .................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ........ .I..~..1...~...,,4~,. ....... IJ..~....,/~,..~..~..~. ..................... Xt~.~. ....... ' .... ........................ .-. ¢. b. Intended use and occupancy ..~..J~.~.....~.....~.. ~ 3 Nature of work (check which applicable): New Bui!ding-. ................. Addition ..... X. ......... Alteration ......... ..... Repair .................. Removal .................. Demolitio~ .................... Other Work ~A~..~.~..~...~...~..~..1~......~.~..~..I. 1~..., 4. Estimated Cost .......~.....~..~...~....~ ............................... Fee :~ j....~...c~ (Description) (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. D mensonsofexstngstructures, fany:Front ...... ~.~...~.IC/. ....... Rear .......~.~..~..~... ...... Depth~../.!...~....,~.,./...~.~, Height ...... /.~'...~....~.. .... Number of Stories ......J.../.(.~.. .................................................................................................. Dimensions of same structure with alterations or additions: Front .................. :.~.. ............. Rear ........... Depth /'1/'~ 'A/ ~ ",~ Height ..... L~..~...'/~. ......... Number of Stories ...~/.....i~. ................. 8. Dimensions of entire new construction: Front ................... Rear ....... ~ ................. Dept .................. Height ..... ..~.....~...t~..... Number of Stories ......'~C... ............................................................................................................ 9. Size of lot: Front ...... ~..~'.~.....~....~'. .................................. Rear ....... I..~'...~....~....'~'. .................. Depth .....~...~....~....~...?'. ........ 10. Date of Purchase ...........~..~.l~.e. ....... ./.~....~....~... ........... Nome of Former Owner /~.~.~.......~.....~....Y...~,. ................... 1 1. Zone or use district in which premises are situated .................................................................................................... 12 Does proposed construction violate any zoning law, ordinance or regulation: ...~..~ ............................................. 13. Will lot be regraded . ...... ~..I~.. ........... Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises ~.~../J.~,..~.~..~....~.,.../~...~..~.,~//~4~/Address .t~_~1~.,(.~/.~ ................. Phone No. ~1~'.:...~.,,.~....~.. Name of Architect "-" .............................................................. Address ................................ Phone No ....................... Nome of Contractor ............................................................ 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. STATE OF NEW YQRI~,~ _ ~S S co~'r¥ o~ ..... :x.'~'"~'~'~'<;'"~- ..... ~.~.~....~x'..~..~;'.~..~.' ................... being duly sworn, deposes and says that he is the applicar,~ (Name of indiv.idual.signing .coatracf) , . above named. k~e ~ th~ ;..~.~ ......................................................................................................................................................... (Contractor, agent, corporate officer, etc.) of said ~ner or owners, and is duly authorized to perform 0r have performed the said work and to make and file this application; that all statements contained in this applicction are true to the best of his knowledge and belief; that the ware will be,performed 'in th* manner set fo~h in the applico~ion ~J~d t~rewith. Sworn to before mo this /I ....... o, ................... g, _./ ........................... ....... ...................................... {Si~noture o{ opplicant) [LI~ABETH A~N NEVILLE NOTARY PUBLIC, S~ate o[ New Yor~ NO. 52.8125850. Suffolk Cou~ Term Expires Match 30. t9