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Home My WebLink About8018-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 8018 Z Date ....................... J~me ........ ~ .......... , 19..75. Permission is hereby granted to: t~.:r~.~.. ~.. ~a~.:¢ii~...z. ¢ r~pzq, o ~1~t ...................... ............ ~ (~)n.i.e ................................................... to at premises located at ..~.~..~,~t...k(~ ........................................................................................... ......................................................... ~el~.~.e ......... ~-~-~- ................................................................... pursuant to application dated ................... .~...~..}.~.....~.~. ................. , 19~..~...., and approved by the Building Inspector. Fee $ ........................ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ...... n;..:::....'.': ................... 19.(~..~... (i/) / c Approved ........................................ , 19.../..:.. Permit No..~ .................................. Disapproved a/,_c._ .;;... ..... .~::~:j,.,L._.z~..~..~?:.~..~-~'...~-- .................. : ................................................... ...;.. ? - :;j~z~-~ ............ ................... ...... ......... ....................... * ' (~uilding Inspector) APPLICATION FOR BUILDING PERMIT Application No ................................. INSTRUCTIONS a. This application must be completely filled in by typewriter or' in ink and submitted in triplicate to the Building Inspector, with 3 sets 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 or 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 Pen'nit 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) .... l~tzz...~ad ......... ~.e~o~i~ ............................................. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .....].{..e.T~.~.~....~]..~.~.]~.g~.~¢~..~'.~. .................................................................................................... If applicant is o corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......... O~.P~t.~ ............................... Plumber's License No ................................................. ~lectrician's License No ............................................. Other Trode's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: ........ ~ ..........................Lot No ......... ~ ........... Street and Number .~.~...[~:[~q...~o~ ....... ~[?~(~)~ .......................................................................................... , , Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ..... ~.¥;e.l&.2.~.~ ....................................................................................................... b. Intended use and occupancy ......... , 3. Nature of work (check which applicable): New Building., ................. Addition Repair .................. Removal .................. Demolition .................... Other Work ........... ...................................... .... 1,~', O0 (Description) 4. Estimated Cost ............................................................ Fee ....................................... .......................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ....r..O...~..~. .......... 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 ................................ 1 2 ,.d. ia 8. Dimensions of entire new construction: Front ................... , ............... Rear ............................ Depth ........................ Height .................... Number of Stories ..................................................................................................................... 9. Size of lot: Front ........................................................ Rear ........ Depth 10. [)ate of Purchase ........................................................ ~]~a~e of Former Owner ............................... l 1. Zone or use district in which premises are situated ~[ res a~r~c ................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded ............................ Will excess fill be removed from oremises: () Yes ( ) No 14. Name of Owner of premises Hertr~.. Step~oski Er Pecon¢], ................................................... Address ................................ Phone No ....................... Nome of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ...................................... ...................... Address ................................ Phone No ....................... PLOT DIAGRAM Loc:ate clearly and distinct y oil buildings whe}her existing or proposed, and indicate all set-back dimensions from property lines. Give street and b ack number or description according to deed, and how seet names and indicate whether interior or corner lot. [ TATE OF NEW YOR[¢,_ .... IS S :aUNTY OF ........ ~..~.U..$[Z:OJ.~....f . ..................... ~.-?..~ ~]en.r..y 8t~pnoski Jr · ......................................... oemg duly sworn, deposes and says that he is the applicam (Name of individual signing contrac0 bove named. le is the .. ow~l~r (Contractor, agent, corporote officer, etc.) said owner or owners, and is duly authorized to perform or have performed the said work and to make end file ~is application; that all statements contained in this applicotion are true to the best of his knowledge and belief; and ,at the work will be performed in the manner set forth in the application filed therewith. Yom to before me this ..................... 2c~y of June 19 ........ .............. ... .............................. ' .M .... , ,., otary Public, Suffol,.k. County (Signature of applicant)