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Home My WebLink About8852-z I~ORM NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COJV~PLETION OF THE WORK AUTHORIZED) No. 8852 Z Permission is hereby granted to: ~.~,~.~..~.o.,r.~..~..e.,n..~.e.....q.o.......~Z.c....~.b.~...~a~te][ ............... .~.~.~.$,.~.~.e.k .......................................... Fee $1..~..'t .,0..0. ............. FOIlM NO, I TOWN OF SOU?IIOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. Approved ................. '~ ~/,.~ ......... ~[~) ..... , 19.2~. Permit No..~.~...~....~....~.. ........ Disapproved a/c ....................................................................... (Building Inspector)/ , APPLICATION FOR BUILDII~; PERMIT Date ...... S~p.~e ml3e~..~., .............. 19.?.6 ...... INSTRUCTIONS a. Th~s apphcation must be completely filled in by typewriter or' in ink and submitted in triplicate to the Buildin,~ Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buddings on premises, relationship to adjoining premises or public streets o areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is port of this application c. The work covered by th~s application may not be commenced before issuance of Building Permit. d Upon approval of this application, the Building Inspector will issue a Buddmg Permit to the applicant. Such peril 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 Occupanc; shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permitpursuant to tjx, Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances'o 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,t, admit authorized inspectors on premises and in buildings for necessary inspe~ions. (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 .......... ............................................................................................................................................................... Name of owner of premises .......... ~:L~.,l:t...~i,.t~;J,~:: .................................................................................................. If apphcant ~s a corporate, signature of duly authorized officer. Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... ~ /~ 1 Location of land on which proposed work will be done. Map,No/Tx~, ',.~'~'//~' '':']; ....................... Lot No ........................ Street and Number ...~a1~.01~. Rd,.. ....................... ./...~-.~..~..~:....C~;~..:,~...~-.,, · ........... : ..... : ..... ~, v nnunicipality 2. Stale existing use and eccupancy of premises and intended use and occupancy of proposed construction: o Exisiting use and occupancy .... 4~z~e..;~.~.~..Lt.we.'J.~.:~.n(~./, /' ~.'~'"'~' ......... , ...... .~ ..................................... Intended use and occupancy .... .oz~e...~.l~.:~,~..~l.~ze31,3,,[.~,~.~~..~/ ........................................ // 3. Nature of work (check which applicable) New Building .................. Addlhon ................ Alteration ........... Repair ................ Removal ................. Demohhor. ............... Other Work ...~e~¢.L,"t~. ............................. (Description) 4. Estimated Cost ..........................................................Fee ..J~.~.,,0.CI ...................................................................... (to be pa~d on filing th~s applicahon) 5 If dwelling, number of dwelling umts .......................... Number of dwelling umts on each floor ........................ If garage, number of cars .................................................................................................................................... 6. If business, commercia~ or mixed occupancy, specify nature and extent of each type of use ......................... 7 Dimensfons of existing structures, ff any' Front .......................... Rear ................................Depth .................. Height ........................ Number of Stones ...................................................................................................... Dimensions of same structure with alterahons or addmons. Front ................................... Rear .................... Depth ............................... Height ...........................Number of Stories ............................. 8. D~mens~ons of enhre new construchon' Front .................................. Rear ............................ Depth .............. v .... Height .................. Number of Stories ............................................................................................................ Size of lot' Front .............. lQ0! .............................. Rear ......................................... Depth ..~.~0!. ................... Date of Purchase ................................................... Name of Former Owner ...................................................... Zone or use district in which premises are situated .............................................................................................. Does proposed construchon wolate any zoning law, ordinance or regulation' . ...................................................... Wffl lot be regraded ........................ Will excess fill be removed from premises. ( ) Yes ( ) No Name of Owner of premises ...A...]...b.~..~.~$..e.~ ................... Address g..q~.q.h...°.~9. .......... Phone No. ~.~..-..6..~.~.~... Name of Architect ........................................... Address ................................Phone No ...................... Name of Contractor ...................................................... Address ................................Phone No ...................... PLOT DIAGRAM Locate clearly and distinctly all buddings, whether ex~stmg or proposed, and mdmate all set-back dimensions frorr property lines. Gwe street and block number or description according to deed, and show street names and in&cot= ~9 I0 ~[11. 12 13 14. whether inl'er|or or corner lot STATE OF NEW YORK, [ COUNTY .OF .,S.~t~.O]~ ............. ~. S S ....~..~..~.~.~'.~.~,.~..o.~...?..T~..~".~..~fJl0.~.m..lT.~.~ ....... being duly sworn, deposes and says that he Is the apphcan~ (Name of individual s~gning contract) above named. He is the ..~.~.~g~ .......................................................................................................................................... (Contractor, agent, corporate officer, etc ) of sa~d owner or owners, and ~s duly authorized to perform or have performed the said work and to make and f~l~ this application; that all statements contained m this apphcahon are true to the best of his knowledge and behef, that the w~)rk will be performed in the manner set fo~h in the appJicabon filed therewith Swo~t~efore me th~s ~ ~ 7 ...... ........ ........ , · ........... ......... Cou, , ~ (Signat of applicant) ELIZABETH ANN NEVILL[ , ~OtARY PUBJJ~, ~t~Je o~ New mo ~2 s~258s0, su~b~Y term Expires Marc~