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Home My WebLink About7918-z FO~tM NO. ~ TOW~ OF $OUTHOLD BUILDING D£P~T~£NT TOWN CLERK'S OFFICE SOUTHOLD, N; Y. ' BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUThlORIZED) N? 7918 Z Permission is hereby granted to: L~..au~e3~L....&JO...~a...O;L.~e~ .................. ................. 2~..¢~.~!~ ......................................... to ..~1~...al~m.a.t,:~an~..&.z~...~.e;~a~..~,~. ~x~t~.~..~,~:~.~.~g~ ....................... at premises located at ....... .Q~..~a..~,Q;~4~[. ............................................................................................... ................................................................. ~..e.~.t..e......~.~.~., ................................................................. pursuant to application dated ......................~t,~r ........ ~J~ .............. , 19.~.~..., and approved by the Building Inspector. Fee $,?,..~..t ..0~... ........... Building Inspector 0 Examined Approved FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ]9,2~..TPermit No .7. f..~,,..,,~,,..~... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a This apphcation must be completely filled in by typewriter or' in ink and submitted in triplicate to the Buildi, Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b Plot plan showing location of lot and of buddings on premises, 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 applicatio c. The work covered by tMs application may not be commenced before issuance of Building Permit. d Upon approval of this application, the Building Inspector wdl ~ssue 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 m 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 tl 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 with all applicable laws, or&nonces, building code, housing code, and regulations, and admit authorized respecters on premises and in. buildings for necessary inspections. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or 5udd.- ............................................. z:.. ...................... Name of owner of premises ........,,I~]:~ft...D.]..q~Z~ ............................................................................................ If apphcant ~s o corporate, signature of duly authorized ofhcer. (Name and title of corporate officer) Builder's L.cense No ..... .~...,...~.~..~...s..e..~.~. ........................ Plurnber's license No ................................................. Electrician's License No ............................................. Other Zrade's L~cense No ............................................... I Location of land on which proposed work wdl be done. Map No ~ Lot No Z_~C Street and Number . ...l~.q~.~.~...~.p.~,~ ........ ..l~ir.~.p~9 ..... ]~.~...'lJ.~ ................................................................. Municipality 2 Slate existing use and occupancy of premises and intended use and occupancy of proposed construction' o Exisiting use and occupancy ...... .cl:)?...e...]..~.~. ........................................................................................... b. Intended use and occupancy ............ ..S~a:..~.?..z~..w..1...~'h....~..~.~.e.~..~:.t;~.~.~.~..~.'e.~..~..~:~ .................................... 3. Nature of work (check which applicable). New Building ................ Add~tion .................. Alteration ...,,~C~., . Repair .....~ ...... Removal .................Demohhon ................... Other Work ................................................... (Description) 4 Estimated Cast ............................................................ Fee. 1.5'o00 (to be po~d on fihng this applicabon) 5 If dwelling, number of dwelling umts ......... .o.?_e. ..... Number of dwelhng 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 ......................... 7 D~mens~ons of ex,sting structures, if any: Front ..................... Rear ................................ Depth .................... He,ght ........................ Number of Stones ........................................................................................................... D~mens~ons of same structure with alterations or addmons. Front ................................... Rear .................. Depth ................................ Height ........................... Number of Stones .............................. 8 D~mensions of enbre new construcbon Front ................... , ............... Rear ............................ Depth ................. Height ................... Number of Stones .......................................................................................................... 9 S~ze of lot' Front .................................................. Rear .................................... Depth .............................. 10. Date of Purchase ....................................................... Name of Former Owner ...................................................... 11. Zone or use district in which prem,ses are s~tuated "~-" d::L$~6 12 Does proposed construction wolate any zomng law, ordinance or regulation: .... .~..O.. ............................................... 13 WHI lot be regraded ..... Z~¢) .................. W, II excess fill be removed from premises' ( ) Yes ( ) No 14. Name of Owner of premises .~,;/~.8,...0.~.h%e..~. ........................... Address ...~...e..a..o..~..a. ............. Phone No ....................... Name of Architect ...................................... Address ................................ Phone No ....................... Name of Contractor . .Leo...~'~.s.s.e].], .................. Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and d~stmctly all buildings, whether ex,sting or proposed, and md~cote all set-back dimensions from property lines. G~ve street and block number or description according to deed, and show street names and indicate whether inter,or or corner lot see attached plan STATE OF NEW "fORK. COUNTY OF .~...'~....~..o..]LL~: ............ S ........................... · Le~...~&lBe.].-~ .................................. being duly sworn, deposes and says that he ~s the apphcam (Name of ~nd~wdual s~gnmg contract) above named He ~s the ....................................... ~).1,z,i,~¢,.~.~ ............................................................................................................... (Contractor, agent, corporate officer, etc ) of sam owner or owners, and is duly authorized to perform or have performed the said work and to make and fil~ this applicabon; that all statements contained ~n th~s apphcat~on are true to the best of his knowledge and behef; an~ tl-,a~ the work will be performed m the manner set forth in the application filed therewith. Sworn to ~fore me this ........................Notary Pul~tic, .day°f ............... .S...tl:~?...o..~..?!'a'~' .................... County' 197'~'" .................. ............... ......... ~ ........ (Signature of applicant) ................. Notary Public, Slate of New York Nc,, 52-0344968 Suffolk County Mar¢h 80~ Cornrnis~cm Expires