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Home My WebLink About7911-z FORI~f 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) N? 7911 Z Date ....................... Ma~ ......... 9 ............. , 19..~. Permission is hereby granted to: ................... 6~po~t ...................................... to ..~r~o.t..~n~.~..~ z...p~r-.. &ppl~a.~;~o~ ....................................................................... at premises located at .... ~O.?,~...t,~...~...~.~.....~e..~r..~8~..~ ............................... ~, ..... ............................... : .......... J~ai.~..l~a~..&..l~pe~ueek..lios4t .......... 6~eeulm~ ....................... pursuant to application dated ......................j~....~ .................. , 19...~, and approved by the Building Inspector. Fee $....J.~.(~) ......... lng Inspe FO~M' NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ^pplicat,on No..Z/...~.~. Disapproved a~..]-- ......................... ................. APPLIGATION FOR BUILDING PERMIT Date .................. ??..a..y.. ....... .9. ............. , 19_.7.5... INSTRUCTIONS a This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildin Inspector, wtth 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing Iocatton of lot and of buildings on premises, relationship to adlmmng premises or public streets c areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this applicatio~ c. The work covered by th~s apphcation 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 apphcant Such perm 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 issuance of a Building Permit pursuant to tk Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances, Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe, The applicant agrees to comply w.th all apphcable laws, ordinances, building code, housing code, and regulations, and: admit authorized inspectors on premises and in buildings for necessary inspections. '~S~f applicant, or name, if a corporation) ....... .q ~,~.e~p.0 ~,.t,.... J:l., X,,, .................................................... (Address of applicant) State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build¢ .......................................................... O.~ff~e.:P ....................................................................................................................... Name of owner of premises .... .~.~e.C...S.~rans~.~c..~Do~.otl-;y .Abbo.%~ ................................................. If apphcant is a corporate, s~gnature of duly authorized officer. (Name and title of corporate ofhcer) Budder's License No ..................................................... Plumber's License No ................................................. Electricmn's License No ............................................. Other Zrade's License No ............................................... 1. Location of land on which proposed work will be done. Map No Street and Number ...... .I.~g.$:P,...lq,.O.a&....~,..-P.~.p~.s..~qe, e,k...li~>ad_. ......... G:peen.pol-.¢- ................................... Municipality State exmtmg use and occupancy of premmes and intended use and occupancy of proposed construction: a Exisiting use and occupancy ..... ..c]..?...e.~..~..~,~ ........................................................................................ b Intended use and occupancy ............... ,~.~Ro,~..~r.Z~;~., ~.~a~.~z~ .................................................................... 3. Nature of work (check which applicable). New Budding ................. Addition ................. Alteration ........... Repair ................. Removal .................. Demoht~or. ................. Other Work ................................................. (Description) 4 Estimated Cost ........................................................... Fee ...1..~.,...0..0. ........................................................................... (to be pa~d on filing thru apphcat~on) 5. If dwelhng, number of dwelhng units ............. .? ........... Number of dwelhng umts 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 ......................... 7. D~mens~ons of exfsting structures, if any' Front ........................Rear ................................ Depth ................... Height ........................ Number of Stones ............................................................................................................. D~mensions of same structure with alterations or additions' Front .................................. Rear ..................... Depth ............................... Height ......................... Number of Stones ............................ 8 D~mensions of entire new construction: Front .................................... Rear ............................ Depth .................... Height ................... Number of Stories ................................................................................................. 9 S~ze of lot' Front ............ 1.5'0.,,~. ............ ,~2~..2.~], Rear ........... D~9 .................Depth ............................... 10. Date of Purchase .................................................. Nome of Former Owner ..................................................... 11 Zone or use district in which premises are s~tuated .... !!~!!...C~:L,~ ...................................................................... 12 Does proposed construction violate any zoning law, ordinance or regulation' ..~O. ............................................... i3 W~ll lot be regraded ..z',o .................... Wdl excess fill be removed from premises: ( ) Yes ( ) No 14 Name of Owner of premises ..~.,...~.~Tk~.QZ~..~..~).~...~,~.]?.O..'b~ddress ................................ Phone No ....................... Name of Architect .................................... Address ................................ Phone No ....................... Name of Contractor .......... .sazag ............................. Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and d~stmctly all buddings, whether ex~stmg or proposed, and red,cate all set-back dimensions from property hnes Gwe street and block number or description according to deed, and show street names and indicate whether interior or corner lot STATE OF NEW Y~DRJ.(,. '11¢ ~ COUNTY OF ..... b.'...¥1~..'.Z..O. .............. ~S S .................................... .~.a.l:~3.~...~lffaz~.~.o.~ ...................... being duly sworn, deposes and says that he ~s the apphcam (Name of individual signing contracf) above named o~m e ~ He ~s the ........................................................................................................................................................................... (Contractor, agent, corporate officer, etc ) of said owner or owners, and ~s duly authorized to perform or have performed the said work and to make and f~le this apphcat~on; that all statements contained ~n this apphcat~on are true to the best of his knowledge and belief; and fL, ar the work will be performed in the manner set fo~h m the apphcation filed therewith Sworn to before me this .................... ~.. day of ................ ~.~:Z ................ , 19 ~ ~ ~; * ~ ~ .................................................. co.. ". ............. ' ......................... ~ (Signature of applicant)