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Home My WebLink About7936-z FOR~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. N? BUILDING PERMIT CFHI~,~. PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMI3J-ETION OF THE WORK AUTHORIZED) ,/' ~s'3!~ ~ z oo,~ ............................ ~ ....... ,~. ........ , ,,.~.. ii' Permission is hereby granted to: at premiset located at .~-~..~,~.--A~--~..~.O~..~' ................................................................... ,,~:',F' ........... ,~ .......................................... ~...~..~:r2¢,.~ ........................................................................... l~ursuant to application dated ............................. ~ ....... ~9 ........ , 19..~., and approved by the B~uilding Insl~ector. Fee $~-~.00-i .......... TOWN OF SOUTHOLD -'~' ' BUILDING DEPARTMENT ..~/IZ?/?t~, ,/~? TOWN CLERK'S OFFICE /c~ ~'~ MUTHOLD, N. Y. .............. .......... .............................. ;/ L~ ~ I TI ................................................ ' .......... NSTEUC ONS a This application must be completely ftlled in by typewriter or ,n 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, relahonsh~p to adlommg premises or public streets, areas, and giwng a detailed description of layout ofproperty must be drawn on the d~agram which is part of thru applicatio. c The work covered by this application may not be commenced before issuance of Budding Permit. d. Upon approval of this apphcation, the Building Inspector will issue a Building Permit to the applicant Such perrr shall be kept on the premises available for inspection throughout the work. e No budding shall be occupied or used m whole or in port 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 t} Building 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 apphcable laws, ordinances, building code, housing code, and regulations, and admit aulhorized inspectors on premises and ir~ buildings for necessary inspections. ~/(SJgr~ature of applicant, or name, if a corporation) HeriCage ]~tome.....~....¢ :...G.o.z~. ..... .8...8...~.......Z.~Q~..~y.Z...g..¢......D..e...e.~..k~. (Address of applicant) 11729 State whether opphcant ~s owner, lessee, agent, architect, engineer, general contractor, electnc~an, plumber or build, Name of owner of premises .....E...m~.n. 3A~l..LQr~.fk~. ..................................................................................... if apphcont ~s a corporate, signature of duly authorized officer. (Name and htle of corporate officer) Builder's L~cense No ......... Plumber's L~cense No ................................................. Electrician's License No .... .s...~..~...e. ............................... Other Trade's L~cense No ............................................... 1 Location of land on which proposed work wdl be done. Mop No ....... ~ ...................Lot No ...~ ............ Street and Number .~./.~...:~.~..J~.~.e, ......... .~&s.~...}.~a~.±~. ............................................................................ Municipality 2. State existing use and occupahcy of premises and intended use and occupancy of proposed construction' o Exisiting use and occupancy .~.~]~.~ ...................................................................................... b Intended use and occupancy ...... s~e...w,%48~%. ~,~..~0,i.~,~ ................................................................. 3. Nature of work (check which applicable). New Budding ............ Addition ..?~.~. ......... Alteration ...~ Repmr .................Removal .................. Demoht~on ............... Other Work ....... ......... i~'ri~ii~)' .......... 4 Estimated Cost ................... ~...~..0..0...0..._+ ...................... Fee .... .1. ... . .0. .0. .................................................................... (to be pa~d on filing th~s apphcat~on) 5. If dwelling, number of dwelling units ........ .o...~..e. ........... 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. Dimensions of existing structures, if any Front ........................... Rear ................................ Depth .................... Hmght ........................ Number of Stones .............................................................................................................. D~mens~ons of same structure with alterations or addmons Front ................................ Rear .................. Depth ................................ Height ...................... Number of Stones ............................... 8 D~mensions of entire new construction: Front ...20 ......................... Rear ...... 2.C) ................. Depth ...... .1.~. ........... Height .................. Number of Stories ...O..~..e. ......................................................................................... 9. S~ze of lot Front ...... 60 .......................................... Rear ............... .~.(~ ................. Dep~ ..]..0.C) ................... 10 Date of Purchase ........................................................ Name of Former Owner .............. ~..'~.....~-R-...'~..r 11. Zone or use d~strict in which premises are situated .. ~!~,!!...0,~-.~.~, ...................................................................... 12 Does proposed construction violate any zoning law, ordinance or regulation: ......... $'ZD. ......................................... 13 Will lot be regraded ........Z~O ............... Will excess fill be removed from premises: ( ) Yes ( ) No 14 Name of Owner ofprem~ses....~ ..... ~o~...~.a6 ........................... Address6..~.?.../......x..~...~....~..~..~.~.'Phone No ...................... Name of Architect ........................................... Address ~:..~'..'.~; Phone No ..................... Name of Contractor . ~.~'~gt~ .~O~e .~,],~.. ~.9~.~ .... Address ....~.~.~.~D.~ ........ Phone No ..... ~.~...(~R~R PLOT DIAGRAM Locate clearly and distinctly all buddings, whether ex~st~ng or proposed, and red,cate all set-back dimensions fror property lines G~ve street and block number or description according to deed, and show street names and ind~cat whether interior or corner lot STATE OF NEW YORK, ~ ~ ~ COUNTY OF ..... J~.t~.f'D'l~ ......... f ~'~ ..................................................................................... being duly sworn, deposes and says that he ~s the apphcar (Name of indiwdual s~gn~ng contracf) above named He ~s the ............................. .b~,~.'t~e~. ..................................................................................................................... (Contractor, agent, corporate officer, etc ) of said owner or owners, and ~s duly authorized to perform or have performed the smd work and to make and fil th~s application, that all statements contained ~n th~s apphcotion are true to the best of h~s knowledge and belief; an tha~ the work wdl be performed m the manner set forth in the apphcation filed therewith Swom tobeforemeth,s ...~...~ ~~~ .................. l~day of .................. ~;ag ....... , 19.75'. Notary Pubic, . ......... ~ ..... J~'~.o3J~..) ............... County ~ . // (Signature of applicant) N~Oq( Pt, bi,c, $~ate o~ ~Hcw York N~, ~-034495~ Sul[fo[k C:ounJ~ Cornml~,~jon Exptres March 30, 19...~