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Home My WebLink About7852-z ~0~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 7852 Z Permission is hereby granted to: · '9 ~ &'~' c...~3:]~.~n ....................................... .... :E.t~o.:L.3:m., od....~ ........................................... ............. ~-b~..~cttc~: ....................................... to e~,a~-...~e~.e-~-~--~--~e ~.-~-~.~.]:~:e-~ ¢-Go~. .............................................................................. at premises located at .~Z~..3.Z~.O~L~,~,,r,~..c,~...;.-~.~e ....................................................................... ................................................. !.:-e ~t.~.~u~:~ ....... .~; ';~;'~ ......................................................................... pursuant to application dated ..................... ~i'~ ........ 2~ ............ 1~...., and approved by the Building Inspector. Fee $:1'-'~. f;~ ............ Examined ...... ~...~.......~..., Approved ........................................ , FOn, M NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMEHT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Permit No..~0~....~....-~.....Z .............. Application No. '~ ~ ~' -) - Disapproved a/c ~ ...... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a Th~s application must be completely filled 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 location of lot and of buildings on premises, relationship to adjoining premises or public streets o areas, and gwing a detailed description 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 wilt 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 in whole or in part for any purpose whatever until a Certificate of Occupanc' 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 c Regulahons, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describec The applicant agrees to comply w~th 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 applicant, or name, if a corporation) .......... .... (Address of applicant) State whelher applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde Name of owner of prem,ses' .... ~.-' ........................ ' - ' ;-~.~. .............................. ' If applicant ~s a corporate, signature of duly authorized officer, (Name and title of corporate officer) Builder's bcense No .................................................... 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 ......... -~.....: ........ ; .......Lot No .............. ~ .... Street and Number .............................................................................................................. :;~.L.~.~x~.'.:.~.. ......... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction' o Exisiting use and occupancy ............ .. ..... .......__~,~4.~..,~-,..-(,-~,,~...~..mw,..,,..,~.,~,,~,.... .............. b. Intended use and occupancy ........... ~ ............. ~~~~..~...~ 3 Nature of work (check which applicable). Nc='~mB~.'!dmg ~ .... Add~bon .................. Alteration ...... Repair .................. Removal .............. Demolmor~ ..... Other Work ~ ~... 4 Estimated Cost ...... ..~..~.t ............................................. Fee . ...~.../..~.5...~...~ ............................................................ (to be pa~d on filing th~s apphcahon) 5. If dwelling, number of dwelhng umts .~..-'~.~..¢r:~,~ .........Number of dwelhng umts on each floor ......................... If garage, number of cars .................................................................................................................... 6 If bus~ness, commercial or m~xed occupancy, specify nature and extent of each type of use .......................... 7. D~mens~ons of ex~stmg structures, ,f any Front .................... Rear ................................ Depth ................ Height ........................ Number of Stones ...~.~,..~r:....c:~,~..~ ................................................. D~mensions of same structure with olterahons or addmons Front ................................... Rear ........................ Depth ................................ Height ........................ Number of Stones .............................. 8 Dimensions of enhre new construchon: Front ................................. Rear ............................ Depth ..~ Height ................... Number of Stones ......................................................................................... 9. S,ze of lot Front ...z..?..o ~ ....................................... Rear ..~.~..~. ............................ Depth ...... ~3...z/..~. ....... 10. Dote of Purchase .?~f.~...~... ,'..~..~, ~-, ................. Name of--F~ormer Owner ','.~, .... ~.~.-~-~.~. ¢~.~.:.:~..?/W~ ........... I I. Zone or use d~stnet m which premises are s~tuated ~ .............. :~ ................................................... 12 Does proposed construchon violate any Tatung law, ordinance or regulation .~ ............................................ 13 Wdl lot be regraded ............................ Will excess fill be removed from prermses: ( ) Yes (,~) No 14 Name of Owner of premises ;~:~rr,~.':¢. ,..,~.r~..Cr .~.. ~..~..-~ ........ Address ¢~-~ ~ ~ Phon~ No.~...~.~.:..¥..~..3.... ·.~. ~" · Name of Architect ........ ¥.~,r.:.~c .................. Address ...... ~.,.~¢~ .............. Phone No ...................... Nome of Contractor ..... ,~.~m¢:~, .................. Address ..... ~.~..-¢. ............... Phone No ...................... PLOT DIAGRAM Locate dearly and d~stmctly all buddings, whether existing or proposed, and red,cate all set-back dimensions fron property hnes G~ve street and block number or descnphon according to deed, and show street ~,~rr~ ancLind~cat~ whether interior or corner lot .,'~'/( /~ ~.~ ~ ,A. STATE OF NEW~Y~K,/ ~/~/~J'l ~ COUNTY OF ~~5 ..................................................................................... being duly sworn, deposes and soys that he ~s the apphcar (Name of individual signing contract) above named He ~s the ..................................................................................................................................................................... (Contractor, agent, corporate officer, etc) of sa~d owner or owners, and is duly authorized to perform or have performed the sa~d work and to make and f~l this apphcahon, that ali statements contained m th~s apphcohon are true to the best of h~s knowledge and behef, an that the work wdl be performed m the manner set fo~h in the opphcation filed therewith. Swam to befor~ me this , ~ .... ......................... ~ (Signature of applicant) JUDITH T BOKEN Netaw Pubhc, Sla~e of New Yo~ No,52-03449o3 Suffolk Coun~ Commission Exp*res March 80, 19~