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Home My WebLink About7850-z FOR~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 7850 Z Permission is hereby granted to: Ge~..2.~:~,~.....~,/.~...~;~:~.o~.~ ........ ........... C~+.cher~ue ............................................... to ...hu52.d~..z~w..~se~e~sc~.y...b~iZ~Z~.g ................................................................................. at premises located at ...~;~t..~...~..~.~...k~.-.~..i,~L~..~-.,A%~I~ ................................................... ....................................... 2~b'~e.v~.~...;~c~ ...... .'~; ~.z.~....*.~ .~ .... kZ~.~Lc ?,.z~gu~ .................................... pursuant to ~pplicotion doted ............................ ~]?.~-3 ........ .~.,~'...., ]~..~.~.., and cpproved by the Building Inspector. Fee $..~.O-e.l~O .......... Budding Inspector FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ....................................... App,cat on No. ................ Approved ........................................ , 19.. . Permit No .................. l pproved .......... APPLICATION ~OR BUILDING PERMIT Date ................ INSTRUCTIONS a. Th~s application must be completely filled in by typewriter or in ink and submitted m triplicate to the Buildinl Inspector, w~th 3 setg 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 oi areas, and giwng a detailed description of layout of property must be drawn on the d~agrom which is part of this application c. The work covered by th~s application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector wtll 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 m 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 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 ~pplicant, or name, if a corporation) (Address[ of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or buHde, .................................. ............................................................................................................................. Name of owner of premises ..... --~,...~... ~'..~..V~ ........ L~...ck,-J~...~.'...~....~.. ....................................................................... If apphcant is a corporate, s~gnature of duly authorized officer. (Name and t~tle of corporate officer) Builder's L~cense No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1. Location of land on which proposed work w. LII be done. Map No ...... ,.J.~...~. ~.,...~..,.J...._. .... Lot No. l.J....~. ............ Street and Number ....~...l~.../...u...~.~...~-zz.. ....... [(P.~.~.~ ........... ~J~...~..~.~...c.~.%~.. ...... ~..~..t.~..' .......................................... Municipality 2. State existing use and occupancy of premises and ~n:ended use and occupancy of proposed construction: a Exisiting use and occupancy ....~..~..t.d~.~..~..T'..~..~ ..........~ ......... /.. ( ......... ~,k,.~.. .) ..... b. Intended use and occupancy ...... .~..~.z..c~.~.-.~ ~'~.(¢~ .......... ..-T ............ l.l.. ~ ...... £~.Z. .~.J~._~ 3. Nature of work (check which applicable) New Building ................. Addition ........ ,.~ ..... Alteration .............. Repair ................. Removal .............. Demolmar, ................. Other Work ..... v -, (DeScription) 4 Estimated Cost ............. .1...O... O..~ ........................... Fee ...I..~....Z..0~... ............................................................ (to be pa~d on filing th~s apphcat~on) 5 If dwelling, number of dwelling units ............................ Number of dwelhng units on each floor ..................... If garage, number of cars ............................................................................................................................. 6 If bumness, commercial or m~xed occupancy, specify nature and extent of each type of use ....................... 7 Dimenmons of ex~stmg structures, if any. Front ..................... Rear ................................Depth ................ Height ........................ Number of Star,es ........................................................................................................... D~mensions of same structure with alterations or additions Front .................................. Rear ..................... Depth ............................... Hmght ........................ Number of Stories ............................... 8 D,mens,ons of ent, re new construct,on' Front ......... /(~).. .................... Rear ....... J.~. ................ Depth ../...~./ ............ Height ...f/.O. ........... Number of Stones ............ / .................................................................................. 9 S,ze of lot' Front ......... J.~.?..O.. .................................... Rear ...~..~...~. ............................ Depth .....~..~...0 ............... 10 Date of Purchase ............ ~..~...~.~ ............................ Name of Former Owner ....C~.'...~....~....~..k~. .............................. 11. Zone or use d~stnct in which premises are situated .... 4~.:~...~,..~.C~:.~.--.~.".[~..~..L....~...r ....................................... 12 Does proposed construction wolate any zoning law, ordinance or regulation ..... J...'~.....~.. ....................................... 13 Wdl lot be regraded ...... /~.O .............. Wdl excess fill be removed from premises: ( ) Yes (---) No 14 Name of Owner of prem,ses ...~Q...~.~.CI~ ...... .~..~..~...~-.~.~ Address ...~.~,.~.[I.~.o,,~.. ~hono No. ~...~...~....~..~: Name of Architect ................................... x ....... Address ................................Phon, No. Nome of Contractor...&...=....~U...?.?CY-.. P~.~T' Address ~ ~."~ .~L.~...e ¢-~ ~'- ' ~"~..c..k..~..c'... j~..¢~..~..Phone No. PLOT DIAGRAM Locate clearly and distinctly all buddings, whether existing or proposed, and indicate all set-I::~ck d~mens~ons fron property lines Gwe street and block number or description according to deed, and show street names (]nd indicate whether mler~or or corner lot STATE OF NEW YORK, ~ S S COUNTY OF .... $~J~fol~; ........... )' ' ............................ Gemz:g~..~.oz~tino ............................. being duly sworn, deposes and soys that he ,s the applicant (Name of individual s,gning contracf) above named He ~s the ........................................oozz.~-r~<~.~z~ .................................................................................................. (Contractor, agent, corporate officer, etc ) of sa,d owner or owners, and ~s duly autho,zed to perform or have performed the sa~d work and to make and fil~ th,s apphcahon; that all statements contained ,n this apphcahon are true to the best of h~s knowledge and belief, that the work will be performed in the manner set forth in the opphcotion filed therewith. Sworn to before me this Notary Pubhc, · - County .............. ~ ........... .,tC....:.V. ....... ......... ...................... "-'/ 'ELIZABETH A'tlN NFVILLC i I',IOTARY PUBL C, SL~e of N~w York ~ No 52,§125~50. Suff,~Ik County Term I~plre~ M~trh 30.