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Home My WebLink About8385-z FOF,~ NO. 2 TOWN OF $OUTHOLD BU~LDIHG DEPARTJ~E~T TOWN GLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8385 Z Permission is hereby granted to: " ~ c~...t~.v, e3.e ~r.:L,~ ~ ............................................ ....... ~in..~aa~ ......... P.e~cl~,,1.et.... ..................... at premises located at ..~*~.~..);O.~...~qO~- ..................................................... ~ ......... : ........................ ., ...................................................... P.~aan~ ....... li[,~[ ~ ....................................................................... pursuant to application dated ........................... ."'~J~l_~ ....... ~ ...... , 19....~6 and. approvedr_.~, by ~he Building Inspector. Fee $..~..~.,~00 .......... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. App,,co,on No ..... ...... Approved ........................................ , 19 .......Permit No ....... .~.....~....~...~ ........ Disapproved a/c .................................................. ~ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date Feb 2)+ 19 7~ o. Th~s application must be completely filled in by typewriter o¢ 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 locabon 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 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 permi 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 Permit pursuant to th, Building 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 inspections. (Signature of applicant, or name, if a corporation) ?ecoz~l¢ ~T.¥. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bullde, O'~rt e z' Nome of owner of premises ...l~...o.~.e.....~..Q?...~.~..~.~.c.~ ......................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ........ g~..~..e..,r. ................................. Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1. Locahon of land on which proposed work will be done. Map No.: .... ~ .......................... Lot No..~r. ............. Street and Number .... S.Z'..$.....~a,.!.z'L..3,.o.a.r]../..,.i,[/.s..Les..~;L~...g~ ............ ,~.e¢.on&.c ...................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a Exisiting use and occupancy .... ~.'~...e..~...];.J:.~'.;.g.....~.,....~..8:?..~.....~..~...J...]:.~..~..~/.~.~ .............................................................. b. Intended use and occupancy .................. ..s..8:~.e....~.~.~.~):.....~..e...~..o..~..~.j~. .................................................................. Loc proper wheth, 3. Nature of work (check which applicable) New Building ............ Add,ban .................. Alteration ............ Repair .................. Removal ................ Demoht~or ........ Other Work .... . .~..e...z): .o...J...~. F~ ........................... (Description) 4. Estimated Cost .......................................................... Fee 1~.00 (to be pa~d on fihng th~s appl~cat,on) 5. If dwelling, number of dwelhng units o~e ...Number of dwelhng units on each floor If garage, number of cars .................................................................................................................................... 6. tf business, commercial or m~xed occupancy, specify nature and extent of each type of use ........................... 7. Dimensions of ex~stmg structures, if any. Front .......................... Rear ................................ Depth .................... Height ........................ Number of Stones ............... Dimensions of same structure with alterations or add,hans: Front .................................... Rear ....................... Depth .............................. Height ........................ Number of Stories ................................ 8. Dimensions of ent, re new construcbon' Front .................................. Rear ............................ Depth .................... Height .................Number of Stones .................................................................................................... 9 S~ze of lot Front ..................................................... Rear ......................................... Depth ............................. 10. Date of Purchase .................................................... Name of Former Owner ...................................................... 11. Zone or use district in wh,ch premises are situated . !.~..A.!~....8...~.~.~?...%~...~..~..~..&...]- ....................................................... 12 Does proposed construction violate any zoning law, ordinance or regulation ......... T/.O. .......................................... 13. W~II lot be regraded ..... .~...O. ................. W~II excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises ..... ~I, OS~..~OZ'~.]L.e.S~:[ ............. Address ....~.f~.C.~.~.:;i..C. ........... Phone No ...................... Name of Architect .............................................. Address ................................ Phone No ...................... Name of Contractor ................ .S&..~.e. ....................... Address ................................ Phone No ...................... PLOT DIAGRAM :ate clearly and distinctly all buddings, whether ex~stmg or proposed, and red,cate all set-back d~mens~ons fron lines G~ve street and block number or descnphon according to deed, and show street names and ind~cat, interior or corner lot STATE OF NEV~.¥p,I?...t¢., ..,. ~ S 5 COUNT'r' OF ...'¢..u'Z'...."k...u'"~":. · ............. ~ ', ' ......... .~..~..~..~'..J..~./~'. ............. ~<~ .......¢[....~.l:...~.~.~Z..~'. being duly sworn, deposes and says that he ,s the applicon (Name of individual s~gmng contracf) above named. He ~s the ....................... Al~.e~%..D~...Q~3.(~. ........................................................................................................... (Contractor, agent, corporate officer, etc ) of sa~d owner or owners, and ~s duly authorized to ~erform or have performed the sa~d work and to make and ill, this applicahon; that oil statements contained m this apphcat~on are true to the best of h,s knowledge and behef, tha~ the work w~ll be performed in the manner set forth m the apphcat~on filed therewith. Sworn to before me this .................. 2-~. day of ............... ]~.e~'b.~,~i~,~.~¢. ..... , 19 Notary Public, . ........................ $.~1..~;¢..O2J¢ .......... County (S~gnAture of applicant)