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Home My WebLink About7900-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) No. 7900 Z Permission is hereby granted to: r~t.lir..Z~.Jah~..~r~ga~&er~ ............. ........... F~.~ .............................................. to. h~ !&. ~_ ~w...pg~mat...g~'~ e~u~e ................................................................................ at premises located at ..... ,~/~..]~1.4,~..,~0a4 ............................................................................ ......................................................................... P~oeaJ:e ....... ~.~.~ ...................................................... pursuant to application dated .........................~ .........'7 ........... , 19..~.~.., and approved by the Building Inspector. Fee $..~.~0~ .......... DATE:_ ~, ,';0 IIFY BI 1 oEFORE TION OR ~ 3. FINAl ~ NOT RESPON STRUCTION Ef FOILM NO. ! TOWN OF SOUTHOLD BUILDING DEFARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. , proved ................. :: ........ ......... , No. 7 INSTRUCTIONS a. Th~s apphcation must be completely f,lled in by typewriter or in ,nk and submitted in triplicate to the Buildif Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing Iocahon of lot and of buildings on premmes, relationship to adjoining premises or public streets areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this apphcatio 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 pern 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 Occupan, shall have been granted by the Building Inspector. APPLICATION IS HEREBY. MADE to the Building Department for the ~ssuance of a Building Permit pursuant to tJ Building Zone Ordinance of the Town of Southold, Suffolk Couhty, New York, and other apphcable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as harem describ~ The applicant agrees to comply with all apphcable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors an premises and in buildings for necessary inspections. ...... (Signature of a~l~'licant,"or name, if a corporation) State whether applicant is owner, lessee, agent, architect, engineer,, general contractor, electrician, plumber or budd If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Plumber's License No ......... 4[:~/IB~'. ........................... Electrician's License No. Oh~tS~:Z-~ ......................... Other Trade's License No ............................................... 1 Location of land on which proposed work wHI be done. Map No ..... ~ ......................... Lot No.. :Z~ ......... ~. ,. Municipality 2 State ex,sting use and occupancy of premises and intended use and occupancy of proposed construction' a Exisitmg use and occupancy .... ~;J~%tz~.'~&"J"'J)~:~'.~J~g~ ............................................................... 3. Nature of work (check which applicable). New Building .................. Addrt~on ............. Alteration ....... Repafr ................ Removal .............. Demoht~or. ........... Other Work ........................................... (Description) 4. Estimated Cost ............... .~.~'131tO00.....~ ...................Fee .... 1 ~'.~-00 ...................................................................... (to be pa~d on fihng thru application) 5. If dwelling, number of dwelhng umts ...... O. ............. Number of dwelling units on each floor ........................ If garage, number of cars ....................................................................................................................................... 6 If business, commercial or m~xed occupancy, specify nature and extent of each type of use '"~'~J~-~'~,~L~,~- 7 Dimensions of existing structures, if any: Front ......................... Rear ................................Depth ................... Height ........................ Number of Stories ........................................................................................................... D~mensions of same structure with alterations or additions. Front .................................... Rear .......................... Depth ................................Height ......................... Number of Stories ............................ 8 Dimensions of entire new construction: Front ...... S~.1~)~-.t.,- .............Rear ...... '2~):~ ......... Depth ...... 2't'0ft ...... Height .................. Number of Stories ...... ~1~ ......................................................... 9 Size of lot: Front ............ &o~:~4~e ......................... Rear ......................................... Depth ................................ 10 Date of Purchase ..................................................... Name of Former Owner ........................................................ 1 I. Zone or use d~stnct in which premmes are situated ...... ttA~...d.~l.~ .............................. ~ ............................ 12 Does proposed construction violate any zoning law, ordinance or regulation: .... ~ ............................................... 13. Will lot be regraded ...... ~ ................ Will excess fill be removed from premises: ( ) Yes ( ) No t4 Nome of Owner of premises '"'P"~E"~"~'~O~I~I~O~I~:~ Address ............ ~tg'~D~:~i~... Phone No. ...................... Name of Architect .......................................... Address ................................Phone No ....................... Name of Contractor ........... ~t~ ............................... Address ................................Phone No ....................... PLOT DIAGRAM Locate clearly and dmtmctly all buddings, whether ex~sting or proposed, and red,cate all set~back dimensions frorr property hnes. Gwe street and block number or description according to deed, and show street names and indicate whether interior or corner lot / see Attached STATE OF NEVZ,~YORK, COUNTY OF ~S.~.~..~..~"llc ......... IS S ......................................................................................... being duly sworn, deposes and says that he ~s the apphcor (Name of individual signing contracf) above named. He is the .....................................0¢,~r~e.~ ..................................................................................................................... (Contractor, agent, corporate officer, etc ) of said owner or owners, and ~s duly authorized to perform or have performed the sa~d work and to make and f~l this application; that oil statements contained ~n this apphcat~on are true to the best of h~s knowledge and behef; an tho~ the work will be performed m the manner set forth in the application filed therewith. Sworn to before me th,s ................ ..... of .... ....... .... ........ -Z: 197 ., '7/, 7 ?, ' Nota ' ................... ~/ /' / // (Signature ,~f applicant) t J, la-y P.I l,c, ,qt,~le c~,~ H~w York tqo 52"03~4963 Su'r.~t~ Cc, (-ornm,~s,~n Exp,re.s M~rch 3~.,~'~ sideS, sides revImlon date: project: : ' rgondi -en drew. by: w.h. 2-2e-75 Van Bou epprc~ed by1 ' ' · ~oale: ,1":20' I , t,~,e., lay-out plan . drawing number: P.O.B°x 188~ Bhlrley, New York telep~one~ [51~! ~BI-0100