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Home My WebLink About8479-z FO~ NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8479 Z Date ........................... J, DZJ. i.....~. ......... , 19.~..~... Permission is hereby granted to: L;., .Petty. A/C l!icholas Bolo~anie pursuant to application doted ........................~.~..~ ........ ~. .......... , 19.~.~..., and approved by the Building Inspector· Fee $.1. ~'.~,Q~. ........... Building Inspector FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, No Y. ,*proved ......................................... ig..Z Pe,m,t ...... .......................... ('~ u~'l'~lin ........................... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No. ,,~-..~.?..Z ................ o. This application must be completely filled in by typewriter o¢ in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. h. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or pubJic streets or areas, and giving a detailed description of layout of property must be drown 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 o 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 port for any purpose whatever until o Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment for the issuance of o Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lows, Ordinances or Regulations, for the construction of buildings, additions or o~terotions, or for removoJ or demolition, os herein described. The applicant agrees to comply with all oppl cab e ows, ordinances building code, housing code, and regulations, and to adm t authorized inspectors on premises and n bu Idings for necessary inspections. //(S gnoture of op¢icont, or nme, if ........ ¢.x.. ........ %. ,,,, (Address of applicoFrf) State,,,cF~ether applicant is owner, lessee, agent, architect, engineer, g~nerol contractor, electrician, plumber or budder Name of owner of premises ...~... L~...~...e....~.X~...~.~ ......... ~,....~... z(.~..~)iii.'~.' i.~"~!"" i' ".~ ........................................ 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 ............................................. O her Trade s L~cense No ................................................ ]. Location of land on whic? p,p~rop,o, sed w/o~rk wil~,be ,d,on¢~_/v~p~l~o.: .~~..~o,t No..../...~.....~.~.. ...... ~ Street and Number .../..<~..~......(¢~..,...~.~..¢~.~. ........... ~~.....~..~.~...~ ............... ~' M~icipality 2. State existing use and occupancy of premises and in~ended use and occupancy of proposed construction: o. Exisiting use and occupancy /'~' .............. ~ ............ : .............. ~ .......................................... b. Intended useandeccupancy ......................... 3.* Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ............. Repair .................. Removal .................. Demolitiar ..................... Other Work ................................................... ,_~ (Description) 4. Estimated Cost ............ .?..,/...~.~.~...~/.4~._ ......... Fee ..[...~. ............ i ..................................................................... (to be paid an filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ garage, number of cars .............................. /, .......................................................................... (. .............................. If 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ..... .~.-..~.. .. 2:. ....... Rear ..;...., .,da~......Z... ......... Depth ..... z-~ ! ne / Height ...... ----'/"~ ........... Number of Sto's .......... ¢. ................................. ,-/~ ,-z:='""2'"'"';,~ ............................... r--~ 7'"-'"v; .... Dimensions of sqme structure with alterations or additions: Front ....... ~-,d.......~.. ............ Rear ...'~.~d... ................ / Depth ....~..~.. ................... Height ........ ~...~. .............. Number of Stories ........~........~ .............. 8. Dimensions of entire new construction: Front .................................... Rear .,...tc.~a. ................ Depth ..... ~....r... ......... Height .....J,,,~.../. ..... Number of Stories ................ ./. .................................................................................................. / ............ ~...,~., :,, ..'~..., ,../. ....... Depth .....d,~.~.../..~/.~..../. 9. Size of lot: Front ............. ,..~......,...,......,..~..~ ............. Rear 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ ] 1. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..................... /.~..0. .......................... 13. Will lot be regraded . ........................... WiJ.I ex~ess fill be removed fram premise~i: ( ) Yes ( ) No 14. Name of Owner of premises .~.:}.'b¢.,....~~...~..'.~.. ..... Address/.~.~...~/~hone No.c~...~..Z....~...('~ Nome eT Arc ~tect ......... ,.~ .................. ~..,..¢......_~,.~... Address ................................ Phone No ....................... of ontroctar ................. No. Locate clearly a~d distinctly ail buildings, (~ether 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 YORK, C~UNTY OF ...... ~S.S 'b"iit~61I~ ......... above named. He is the ................................................................................................................................................................................ (~'hl?~D~[~O~gent, 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 thor the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ~/ /,,~,,~,,~ ......... ~tI ....... day of '"~tZ ............................. , Notary Public, . .............................................. County ~......~....'V .......\........' ..x.......%..'F_.:...~... ........................................ [LtZA8 ETff ANN