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Home My WebLink About7686-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 PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7686 Z Date .......................... ,Tz~ nZ~__n Z:~......1.0..., 19~.~.... Permission is hereby granted to: 6~'~,b;t e.. A? p ]-ta~c~s.....:Ine ............................. ....... ~a~..~o~ ......... F~a~.~l~.uek ................... to .~.c .~...8.. ~d;L~.. s~:t~r~a,..t ~.~e ~....~o...~.~.. f.t .. he,t g.th .................................................... .......................... .(~,~ra~e~l..h~..~...~r. aal~z ............................................................................ at premises located at ....~/~--~,&-~..~O~ ........................................................................................ ~tt ~tuek I~ .Y. pursuant to application dated ...................... .~...O.?.........2..~. ................. , 19?br........, and approved by the Building Inspector. Fee $.~,~[.I;~ ........... Building Inspector costae NO. i TOWN OF SOUTHOLD ZAIrs - ollz� BUILDING DEPARTMENT ,p TOWN CLERK'S OFFICE cy SOUTHOLD, N. Y. a„/, / Examined ....1...............c......�......, 1922. C ` /_ `� Application No. ..�6 1�.............. Approved .....l.Q.......... lAZs Permit No. 766 (.�" .............. Disapproved a/c ..... . ........... S� ........................................................................... O . .... ........... . ...... (Buildi Inspectod m � � tv APPLICATION FOR BUILDING PERMIT ° o O.: Date ........ 0.A14eMjP.(,'.A..�.., 19...75!... INSTRUCTIONS a. This application must be completely filled in by typewriter or, in ink and submitted in triplicate to the Buikfing 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 of property 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 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. ,r ...,.V.......... 4�-gnna�*i�ure� of icont, or name, if a corporation) 111 .... ..... . . ...1 � (Address of applicant State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber ,or builder. 0(4121-4 ...................... ......... .... .......... . ................................................................................................. NamR ...... P�.......I.e?!F41 /.././ ................................................................. If a s' oture of dul uthorized officer. of corporate offic.................................................... Plumber's License No. ................................................ Electrician's License No. ............................................ Other Trade's License No. .............................................. 1. Location of land on which proposed work will be done. Map No.: ................................ L t No. . ...................... Street and Number . l� s.�R ..mGFf�...�A 7F.�.�... �.a. �../..1..�.L �r ..n.. . . ��, a�-� ' 6nicipality 2. State existing use and occupancy of�reemisees and intended use and occupancy of proposed construction: a. Exisiting use and occupancy �:�!.... t? ,.1�, Gt 10 /tue.v............ b. Intended use and occupancy .G� . I 4\ J u 3. Nature of work (check which le): Neve Building ............ .............. Alteration ... ......,. .. "f Other Work . Repair .................. Removal .................. Demolition.........,.......... .. 7. ( f ri tion) CJ P 4. Estimated Cost ...........Fee ...........&.—!� .:.................................... 1,,< (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................Number of dwelling units an 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 some structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................Number of Stories ................................ 8. Dimensions of entire new construction: Front ....................:............... Rear ............................ Depth ........................ Height . xf7f .. Number of Stories ...............1../1.x... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ......................................................../Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ...t.7 •........................................................................................ 12. Does proposed construction •w�tiolate any zoning law, ordinance or regulation: 41,0116f .............................................. 13. Will lot be regraded ........../.. .............. Will excess fill be removed from premises: ( ) Yes ( �No 14. Nome of Owner of premises .................................................... Address ................................ Phone No. ...................... Nome of Architect ...................................... Address .. Phone No. ...................... Name of Contractor .... fr........................:.......... Address .. .......�.......... Phone No. . ...................... PLOT DIAGRAM a� 3� Locate clearly and distinctly all buildings, whether existing or proposed, and indicate II ast-back dime ons from .r property lines. Give street and block number or description according to deed, and sh street names an indicate whether interior or corner lot. ell K lit ' r � . q•��.' IOOr 1.rL.t ' �S'Tox G n.; is PA, k� cG ry ly f91v��' RT � y STATE OF roi l COUNTY O .......JS.S .................... ......................................................being duly sworn, deposes and says that he is the applicant ( idual siring contract) above name Heis the ..........................l. 1tY. �`^............. 4%.. ."".................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or erformed the said work and to make and file this application; that all statan+t�rrts coR+toittgd in this applicoti or t to the best of his knowledge and belief; and attar-the work'will be perfbr?vred M-0 monnar set forth in the a lic "i led therewith. Sworn to fare me this ....... lam.Vw of 19. . 4 Notary Public,/�...,....... .. Opp cant) T. BOKEN Notary Public State of New York No.52-034496 r(folk Coun 19V CommisatOn E'P ah SC 19 �r,;�