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Home My WebLink About7840-z FORM NO. 2 TOWN OF SOUTHOLD 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? 7840 Permission is hereby granted to: .f.~,~;L..~..k!~zg~.~.e...~.....~..~.e.~ .................... .......... ~i~.~t ~t~.k ........................................ t~ .ft:c.~.~..~p.2...m~JJa.C~.;Lr~..~:.e.~r...~..~.c.~.~...Te,~.cL.~e,~,,.¢.;~ g....q.~...r.~.~...~£:~...:k.q~.'q~..o.~. ...... o! premises located at ~O.~....L]'. ...... SZi,~q.t..S.. ~S.~a~S .................................................................. ............................................................ ?.~../~..~.z..t..~ a..h.!..s.,...L.~.n..~ .............. ~,i.a...t..t...~..t...u..q~. ...................... pursuant to application dated .................... .-~.~.$~......~.3 ............. , ]9.~.., and approved by the Building Inspector. Fee $...1.~..t.~ .......... F~=25 00' ° THE LOC.~iTIOI~' OF l~'E£r.~ ZrZD CESSPOOL~ SHOWJ'I HEREIN ARE ~ROr, I FIEr, D OI~SE~VATIO~S ANDIOi2 ~'RO~,! DATA OBTAII~IED FI~OM OTHERS NOTE: m= MONU/~fENT SUB DIVISION MAPFI£ ED IN THE OFFICE OF THE CL £1~H OF SUFFOLK CO UN T Y ON FED 19 1974 AS FILENO REV,S,ONS YOUNG & YOUNG/~,~ ~ ALDEN W. YOUNG F.~, ~,'~'/~_~,~,~?,~ YO:5~J~G ~ ~Oy NO ~,"E~UAH~ ~ANE ~STAT~~m~ / . . _ ~, ~~J GUARANTEED TO: Ar MA T TI TUCK NOME rITZ ED/K/S/O~ OF CH/CA GO T/TLe /N~U~mNCE CO · o~. OF ~OUTHOLD ~VE~EAO SA~NGS BAN~ SUFFOLK C0./N.Y. eY~~ ~ ~. FO~M NO. I (~ ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 19__.)~-~ ~ ........ ~erm~t No.. ..,..... ..... ~ ..... APPLICATION FOR BUILDING PERMIT .......... ...... I NSTP, UCTiONS a This application must be completely fdled in by typewriter or 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 lecahon of lot and of buildings on premmes, relationship to adjoining premises or public streets o, areas, and giving a detailed descriphon of layout ofproperty must be drawn on the diagram which is part of th~s application c. The work covered by this apphcation may not be commenced before issuance of Building Permit. d Upon approval of this application, the Building Inspector w~ll ~ssue a Building Permit to the applicant. Such permi shall be kept on the premmes available for inspection throughout the work. e No building shall be occupied or used in whale or in part for any purpose whatever until a Certificate of Occupano, shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment 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 Regulahons, for the construction of buildings, additions or alterations, or for removal or demohtion, 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. ..................... ( 'g Jre(~f applicant, or name, if a corporation) ....... ...... .......... (Address of applicant) State whether apphcant ~s owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or budder ............................................. ............................................................................................................... Name of owner of prem,ses ..... .~...&..~.....L.. ....... ..~.......~.~..t.~.[~....~?...~.f~..~.~..~ ...... ~.~.TC h ................................ If applicant ~s a corporate, signature of duly authorized officer. (Name and htle of corporate officer) Builder's License No ........ J~..~.: ............... Plumber's L~cense No ................................................. Electrician's Lmense No ............................................. Other Trade's License No............................................... L~I J/4~ ~'c '- ' ' Location of land on which pj~opos~_d work wil! be done p (~ . . :.Z ....... .T. ............. .~ .... LO ~'~ ......................... Municipality Stale existing use and occupancy of prej~es and intended use and occupancy of proposed construction: 3 NQture of work (check which applicable) New Budding ............... Addition ................. Alteration .......... Repair ................ Removal ................ Demahtlor ................. Other Work ......... ~ ~l.J~..(?... .................. (Description) (to be pa~d on filing th~s apphcahon) 5 If dwelhng, number of dwelhng units ....... ~.....'~... ........ Number of dwelling umts on each floor ......................... If garage, number of cars ............................................................................................................................... 6. If bus~ness, commercial or mixed occupancy, specify nature and extent of each type of use .......................... 7 D~mensions of ex~shng structures, if any Front ........................ Rear ................................Depth .................. Height ........................ Number of Star,es .......................................................................................................... D~mens~ons of same structure w~th alterations or addmons' Front ................................. Rear ................ Depth ............................... Height .................... Number of Stones ............................. 8 D~mens~ons of enhre new construchon Front ............. , ............... Rear ............................ Depth ................. Height ................... Number of Stories ................................................................................................... 10 Date of Purchase ................................................ Name of Former Owner ...................................................... Il. Zone or use dmtnct in which prem,ses ore situated./~...1~...(....~.../.... ......................................................... 12 Does proposed construction violate any zoning law, ordinance or regulation .... .~......C~.. ...................... '"'"'..." '.'. 0 13 Wdl lot be regraded ........ ~ ............. W~JI excess fill be removed from p. rem~ls~s_: (,) Yes ( ) No ! 4 Name of Owner of premises .................... Address .... ,,,~-~.. No. Name of Architect ........................................ Address ................................Phone No ...................... Name of Contractor ...... ..~..~...~'~"-~...' . .............. Address ................................Phone No ...................... PLOT DIAGRAM Locate clearly and dishnctly all buddings, whether ex~shng or proposed, and indicate all set-back d~mens~ons frorr property hnes Give street and block number or description according to deed, and show street names and ind~cah whether interior or corner lot COUNTY OF .....~,0~~ ~'~ ~- f /I /1 --~'"'"""' ~ /,/ d/ // ...................... ~--~'..0~T...'~....L~.,.,.o~......~. being duly sworn, deposes and says that he is the apphcani (Name of~mdw~dual ~/gning contract) above named He ~s the ............................... ~...~.......~..~.~ ................................................................... (Contractor, agent, corporate officer, etc ) of sa~d owner or owners, and ~s duly authonzed to perform or have performed the sa~d work and to make end this application; that all statements contained ~n th~s apphcation are true to the best of his knowledge and behef; ant tha~ the work wdl be performed in the manner set forth in the application fded therewith Sworn to before me this ................ ~day of ........ r'-'-~~~ ......, 197.~..'~__ //Lq~,~/~n~V L~/,-4,~Jml~' ~a~ ~ ~j ~ j . ........ .... co.. ...... o, ....................