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Home My WebLink About9035-z FOI~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPAI~TMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST DE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9035 Z Permission is hereby granted to: 0r ~,e. ~.~ o.~...~.~.e...e,,...C.,o,.....AZ.9.,...~.,a.~.a.~.,. ~.~..z..Z. er ............ ,dt;h _ ~.t... ~.,r,e.e.~:p.~.r..~ ............................. at premises located at Lot~ third St (~t) Laur.e. 1 pursuant to application dated ............................. ~,O,.~..8. , 19.~..~..., and approved by the Building Inspector. FO~ NO. ~[ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ........ ......... i9:2.2. No. Z ,~proYed ................................... ~..., Permit .... ~..~. .......................... Disapproved a/c ......................... :.-.T,;, ,~7~. ........... ~..-~ .................. APPLICATION FOR BUILDING PERMIT Date ............................................... , 19...~..6/.. .... INSTRUCTIONS a. This application must be completely filled in by typewriter o¢ in ink and submitted in triplicate to the Building Inspector, with 3 sere of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets of areas, and giving a detailed description of layout ofproperty 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 wilt 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, Ordinances 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 necessary inspections. ......... ............................................ (Signature of applicant, or name, if a corporation) ................................ ('X~d ~;;~'; g~"~ii;;'~" ............................. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises If applicant is a corporate, signature of duly authorized officer. (Nome and title of comorate officer) Builders icense 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.: ~'~/ Lot No../..~...:':../..:.~.. ...... Street and Number . ~.~x~): ·.~7.~.~.~,Q-Z.~ .~,,~...~,~.,~,.~ ........................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: O. Exisiting use and occupancy ~./.~../~.~./.~7~./.'~...~`Q~.../..~..~.~.~.Q/~.~...~.~./~.~-~ ............... ~ ........................................ b. Intended use and occup0ncy ............... ~.. ....................................... ................................................ 3. Nature of work (check which applicable): New Building,. ................. Addition .................. Alteration ............... Repair Removal Demolition .................... Other Work / (Description) ,~ Estimated Cost ............................................................ Fee .r,,,/.:,~,,.:~. ...................................................................... (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. 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 .............. -,~--~/' .~...~.:..~7...'. ....................... Rear ........ .~.~.~....~.~..~. ............. ,, , ~,,-~ ~-~/ // _ ,~--,~ ..... Depth .Z~.~..~.~.~..Z..~...:.O...,.~ 10. Dote of Purchase ..... /..X.~....~. ....................................... Name of Former Owner ....!.~.:~....,'(...~.(.~.?./..//......~..C./..~/,~T'./Z...~. ....... 11. Zone or use district in which premises are situated ....J'/ ............................................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: .../.'~: ................................................ I3, Will lot be regraded .../.~'. ................... Will excess fill be removed from premises: ( ) Yes ( ) No ~ · No.;.:~.~:: ~j..~/ 14. Name of Owner of premises ....... ..~....b{..~.~ .~..,., .~.,.J.I~..L..//L.~./~.. Address ...~...~....~".ZT//////~,, .2TZ... Phone Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor . .~.'..~...~-.~/Z'.~.~,'~......~.~.?~.~4~......~-!.~.; ....... Address ............. ~, ~ c'~Jr.. ~..~/z, ~hone ~o .................. ¢..'.F. zz-. PLOT DIAGRA~ Locate clearly and distinctly all buildings, whether existing or proposed, and indicate oil 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 Iol. COUNTY OF ~~[.[ ........ ~ ' BIA~ ~ ~ ( f ' ............................ /~ ............................................................. being duly sworn, deposes and says that he is tne' applicam (Na~ ~ indi~l sight, cf)' above named, / /~ ~'~ / ~ ~.. / ................. ........ .:- .............................................................. He is t~e of soid owner or owners, end is duly ~uthorized to perform or heve per¢ormed the s~id wor~ end to m~ke ~nd file this ~pplicetion; thet ell statements contained in this applicetion ere true to the best of his knowledge ~nd belief; end tV,~ the work will be performed in the menner set fodh in the ~pplicetion filed t~erewith. Sworn to before me this ~/ ~ ~'~/ ................. ~d~ o~ ............ ~~> ....... , ~,...::.../~ ~. ~ n .~ . ~~, . ,~ZZ . No,~ ~b c,. ...................... ' ,~, ........ Co,,U ......... ~~..~....~ ................................