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Home My WebLink About7955-z FOR~ 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) N? 7955 Z Permission is hereby granted to: ...~.~.!.,.!~ ...... .~ ....... ...~....~.~.!...c.../..~. ........ ~.y.e-~ ~-n ~ at premises located at ~/~'0 L) h,t C4--~ ~'~ V'/.~"' ............................................................... ~.~.~. ~ o ~ ~ pursuant to application dated ............................... ../~..?....~. ...... ..~...~.., 19.Z.J'..., and approved by the Building Inspector. ..... ............ ~:I/~..,.~<.....~....,. ./.~ .......... Building Inspector F~F,M NO. I TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, H. Y. Examined .............. ~-~......~'.....~., ]9..Z..?~_ Applicotion No....'~...?.....~..:..~:. ....... Approved ................... .,~..~L~.~.....'~..Z 19..'~..?.. Perm,t No. 79 ~/- -~ ~ D,sapproved a/c ........ ~ ............................................................... ............................................................................ ..... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ......... /~/~- INSTRUCTIONS a Th~s application must be completely filled in by typewriter or' in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan show~ng location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this apphcation. c. The work covered by this application may not be commenced before ~ssuance of Building Permit. d Upon approval of this application, the Building Inspector w~ll issue a Bmldmg Permit to the applicant. Such permit 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 Occupancy 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 thf Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and t, admit authorized inspectors on premises and in buildings for neces~ry inspections. (Signature of applicant, or name, if a corporation) x .......... (Address of applicant) State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ............. ........................................................................................................................................................... Name of owner of premises ..... ,~,~t~,&~...~... ¥....~.~.~-~/.~1.~ ../~...~.~:~ ................................... If applicant is a corporate, s~gnature of duly authorized officer. (Name and t~tle of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's Lmcense No ............................................. Other Trade's License No ............................................... Location of land on which proposed work will be done. Mop No ............................. Lot No ..................... Street and Number .... ~.~.~.....~.f~..qZ~.~....~..?..¢~.~ ................. ~.~.;..~A¢'..~ ...................................................... Municipality State exmsting use and occupancy of premises and in'ended use and occupancy of proposed construction' a Exlslting use and occupancy .................................................................................................................... b. Intended use ond occuponcy ...~.v~..,~.~w.r....., ..... ,.~ ........................................................................... 3 Nature of work (check which opphcable) New Building ......... Addmon ...... .~. ...... Alteration ........ Repair ................ Removal ............. Demohhor ...... Other Work ./~-T4/~.%.~ , .9~ u '- (Description) 4 Estimated Cost ,. /,) ........................................... Fee ........... . ,~.....0. .............................................................. (to be pa~d on flhng this applicohon) 5 If dwelling, number of dwelhng units ..................... 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 Dlmens,ons of exist,ng structures, If any Front ..... ~'..~.. ........... Rear ....... c~.~,.~. ............. Depth ...2~,~..,,~. ...... ~"h Hmght .... r"'"', ...........Number of Stones ...~. ............................................................................................. D~mensions of same structure with alterat,ans or add,t,ons Front ..... ~4D,. ~'..! ................ Rear .... ~..6!/. ........ Depth .... ~'.~,..'~.!. ............ Height ~.~". .............. Number of Stories .... /. ................ 8 Dimensions of entire new construchon' Front ......... ,~'[.d..~ ................. Rear ...... c~.~.~ ............Depth ..... ./.~.~. ....... Height ~.~.". ........... Number of Storms .... ./. ...................................................................................... 9 S~ze of lot Front ....... .'7~.~..~.94..'. ......................... Rear ........ ~.~., ./~.../. ................. Depth .~./.z~.:.h'~.D..../. .......... 10. Date of Purchase ..... .-.~.~'2~.. ..... ..~.~.. ................. Name of Former Owner ...~....~....~..~.~.~..~Z~ ................ 1 1 Zone or use district ~n which premises are situated ..~./ ............................................................ 12 Does proposed construchon wolate any Tatung law, ordinance or regulahon' ....~... .......................................... 13 WHI lot be regraded ..... ~..~ ........ Will excess fill be removed from premises' ( "~FYes ( ) No ~4 Name of Owner of prem,ses .~/_..9. ~..~.,,~/..../~//,/~-~,4:7. F/~". ....... Address ~.....z~. ............ Phone No.~.~,~'~.~'...~.. Name of Architect ......................... Address ................................Phone No ...................... Name of Contractor .~?~r.~¢. · . ......................... Address ................................Phone No ...................... PLOT DIAGRAM Locate dearly and dishnctly all buildings, whether ex~stmg or proposed, and mdmate all set-back dimensions fron property hnes Gwe street and block number or descnpt~on according to deed, and show street names and indicah whether interior or corner lot ~I~i.."/~'..f/,Ot~E/~- -. - ' STATE OF COUNTY OF ............. .~: ....... h.E~.E.~..~.~E .................................. being d.~y .~o,., d~=o.e, and ,~y. ~h~ he ,s ~he (Name of mdiwdual signing contract) above named He ,~ the .O.~..~LE.%, .............................................................................................................. (Contractor, agent, corporate officer, etc ) of said owner or owners, and Is duly authorized ta perform or have performed the sam work and to make and this applicahon, that all statements contained in this apphcohon ore true to the best of his knowledge and behef, a~ that the work will be performed m the manner set fo~h m the apphcatlon filed therewith. Sworn to before me thru ............. ......... ¢ .... .... ............ fU~tTH T BOKEN (Signature of opphcant) ~.~2-~9~3 Suffolk Coun~ . ~ ~ ~ch 30, 19~/