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Home My WebLink About8166-zFOuM NO. ~ 'I'O~N OF SOUTHOLD BUiLDiNG DEfARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PEEMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8166 Z Date ......................... A'C4~ ....... ~r/ ............ , 19...?~ Permissio~ is hereby granted to: P.,...i4-e~.eJe-z'a~ .................................................... ...... 30~ ....... h.~'"~t:~,~ii'l= ................................. ............. A.~'~.~ ....... ~vYv ................................. toe r~c~..az~d..a~,r,t,a.i~...~.t,~n.$, .. ffel,~ .. £~nc~g .-~wood~'"~u'--s-' · ~" ~"" ~')' ct premises located ~t ...~.~t..~.....C, el~t~..~d~-..B~'c~,s ............................................................. ....................................................... ~e~t~e-l...D~.~e ....... ~e/c t ~'~c~-ek""'~ ;Y'v .............................. pursuant to application dated .........................X~j~'""~'~ ............... 19.'~.., and approved by the Building Inspector. Fee $.:!..~;.00 ........... I ~J'~" Builcllhg Ins]per'or ( FOIL~ NO. 1 ~ TOWN OF SOUTHOi~D BUDDING DEPARTMENT T(~/N CLERK'S OFFICE SOUTHOLD, N. Y. ~prov~ ........................................ : 19..Z~. Permit No...~Z.~..~,.~ ...... Disapproved ~;;:'.': ................... ,, APPLICATION FOR BUILDING PERMIT pat .... .~..:~i:~ ........... ~9..~.L.. 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 m 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 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 M~ADE to the Building Department for the i~suance of a Building Permit pursuant to the Building Zone Ordinance qf the~own of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the constr~ction.0f buildings, additions or alterations, or for removal or demolition, as herein described. agrees to comply with all applicable laws, ordinances, building code, housing code, and regul~ions, and to inspectors on premises and in buildings for necessary.~ections. / ~(,Signature of applicant, or ndr~e, if a cor~p6ration) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................... .~...z~:~:~z.~...:~.~....;...~~ .~-.. .................................................................................................................. Name o' owner of premises ............ ............................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of C/~t,;~.O,~,7~ ,' -- Builder's License No ........ ~~ ....... Plumber's License No ................................................. Electrician's License No ............................................. Oth~[~ Trade's License N° ............................................... ~ ' ~ "~' '~L.°.t...N.:~-Z~: 'L/~'''"'"' .i....'~-.. Municipality / State exist,ng use and occupancy or~re~ o.d in:~ded,use and occupancy of proposed construction:' a. Exisiting use and occupancy ....... ~;'""i't ............ ............................................................ Repair .................. Removal .................. Demolitior, .................... Other Work ..................... ~..... .... ~ ...... (Descrip¥i~n) ' / --'~' t--o'" Fee / ~-- (to be pai(~ 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 ......................................... ,'~. ~ 0' ..................................................................../~o ..._~.., 9. Size of lot: Front ....~..~.....~.....=. ............................ Rear ........ .~...~.....~,~... ............ Dap, th, ...... 10. Date of Purchase ............~......../..7...(~.~./. ................. Name of Former(~wner .............. ~:. 1 1. Zone or use district in which premises are situated ..................................................................... /Z. ............................. 12. Does proposed construction do[ate any zoning law, ordinance or regulation: ........................................ ................ 13. Will lot be regraded' .,,,~r;.:;~T~:.-'~......,/....~,~ ~'~~Will excess fill be removed from 14. Nome of Owner of premises..~.'. ........... Address one No. Name of Controctor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate ail 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. STA-1'E OF NEW,YORK t S S COUNTY OF .,.J~..~.~..~ ...........f ' ...~..JJT,'3..../(.:'/~.[~.~.~.~..[~...~..( ...... ./~.~...Q'...O...J~....~.~..~.~.~.}/. ............ being duly sworn, deposes and says thot~he is the applicam (Name of individual signing contract) above named. He is the ................................................................................................................................................................................. (Contractor, agent, 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 that the work will be performed in the manner set forth in the applicatj~9 filed therewith. Sworn tabefore me this // ,, .... ~i~..?;~ -V ........ dq¥-'~,f .......~...~...... ................ , 192. J.... //¢/~ ./¢ · .////. ~,~,. Notary Public, ..~(L~'~.~'....~.~.~.~..'f4~r;~f./...'.. County ....... ~...~ .......... ~... /// (Signature of a~)plicant) L/ JAMES DEMETRIS ,Notary Public State of New York No. 24-4512158 Quatifled in Kings County ~ommiss~.on Expues ~arch 3u, 197'~