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Home My WebLink About7976-zTO~VN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7976 Z Date .......................... .~..V~.e.. ........ 3 ........... , 19...ff...~ Permission is hereby granted to: ..... Alb~.r.t,..Z~-'~ctteskl ...................................... .............. lia.tt£tae3c ........................................ to .~.~.~.~...ap~I..~z~J_n.t~in..f.a~i~g..~ s...per...a~ ~].ic.~tion...-...~f.~.. ~ rnr~t ..yar -~.. ~r e a s ...... ..6.~.~.~...a~.4~....a....r.~.ar.. ~m~.6.....a r.a ~.a .................................................................................. at premises located at .... l~lt~..J~.l~..I~nel..&,.};~r.a~ze.,.~:~>ad. ...................................................... ................................................................ ~a.t ~.i. tuek.-....--~ ,,--~., ................................................. pursuant to application dated ........................s.T. UD.f~ ..... ~ ............... , 19...~?., and approved by the Building Inspector. Fee $.1,..~,;,.0,.0,, ........... ~uilding inspector~ "" I TOWN OF SOUTHOLD BUILDIHG DEPARTMENT TOWN CLERK'S OFFICE .~ .7....~.. ~OUTHOLD, N. ¥. Examined ...... ....~.. ........ , 19 prov .... L/.. ....... ......... ....... , .... Application No...~...~...Z.,.~.. ........... Disapproved a/c ........................................................ (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ................................ ~ ~ .......... , ]~.~...!: INSTRUCTIONS a This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildin Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets c areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this applicatior c. The work covered by this apphcohon may not be commenced before msuance of Building Permit. d Upon approval of this application, the Building Inspector w~ll issue a Building Permit to the applicant. Such perm. shah 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 Occupanc 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 th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances c Regulahons, for the construction of buildings, additions or aiterahons, or for removal or demolition, as herein describe, 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 necessary inspections. (Address of applicant) State whether apphcant is owner, less~, eng~neer,~, general contractor, electrician, plumber or builder If apphcant ~s a corporate, signature of duly authorized officer. (Name and title of corporate~l~._ . . /F,~_ '/.v.°fficer)-- Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... ~ ~ y Location of land on which~l~oppseq~wor~, will b.O~lone. _~VCp No ........ ~ ......, .......... ~,~.,Lot-~,g...¢ ... // ............ Street and r~umoer ...~.....'~..~..z .................... ..-qr; ....... ~...~. .............................................. ~ ........................................ Municipality State existing use and occupancy of prenci~es~Lj)~p~4and ~nten, ded use and occupancy of proposed construction: a Exisitmg use and occupancy ........ ~ ........ .-: ...... J.j ................ ., ....... /. ....... ~ .............................................. b. Intended use and occupancy ..................... '..: ............ !'"""'~'"'~"~"~" ...... '~'"~:'~'"~"'~'~';:~'i .................... 3. Nature of work (check which applicable). New Budding ................. Addmon ........ ~ ... Alter~t!on ............ Repo,r ................. Removal ._~...~..,.~...~____.Demolit~or. .............. ...&Ot~ Work ..... !'"'"~'""~"'~iil~'!i~ni .......... .... 4 Estimated Cost ......................................................... Fee .............................................................................. ~b~),.- (to be pa~d on filing this applicahon) 5. If dwelling, number of dwelling units ....................... Number of dwelling units on each floor .......................... If garage, number of cars ........................................................................................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .......................... 7 D~mens~ons of existing structures, if any Front ........................ Rear ................................ Depth .................. Height ....................... Number of Stories ........................................................................................................... D~mens~ons of same structure with alterahons or addmons: Front .................................... Rear ...................... Depth ................................ Height ...................... Number of Stones ............................. 8. Dimensions of enhre new construchon. Front .................. , ................ Rear ............................ Depth ................ Height .................. Number of ~-<;~r.i,e~F ................................ ~.~./...~..../ .......................... i~.~l..;.) ................ 9 S,ze of lot Front ....................../.....~..4. .......................... Rear .................... ./ ................... Depth .............................. 10. Dote of Purchase ................................................... lX~meT~fofm, er Owner ....................................................... I 1 Zone or use district in which premises are s~tuated .................................................... '/['/"t) ........................... 12 Does proposed constructior} ylo.~te any zoning law, ordinance or regulahon' . ...................................................... 13 Will lot be regraded .............~JU.v~.m./).~.. ~.ill p~cess fill bl removed from~lr~e~ ( ) No 14 Nome of Owner of premises .................................................... Address ................................ Phone No ...................... Name of Architect ......... .~.~-rz'ZZ..%~.~ ............ Address ................................ Phone No ...................... Name of Contractor ..................................................... Address ................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buddings, whether ex~sting or proposed, and ~ndmate all set-back dimensions fret property lines Gwe street and block number or descnpt~on according to deed, and show street names and indmat whether or corner lot ,,,I,,,. ..... STATE OF NEV*/'-~OI~I/. /} COUNTY OF :~t¢~,~.-~ ......... f'~"~ ........................."~"'~*'~"--'-"~Z//~.,.,.~..~;.,.....~:~ ......... be,rig duly sworn, deposes and says th~, he ,, the apphca (Nam~of ih~wdual s~gning contrac~ above named Ho ~s tho ......................................... ~: ...... 7 ............................................................................ (Contractor, agent, corporate officer, etc.) of sa~d owner or owners, and ~s duly authorized to perform or have performed the said work and to make and f this apphcahon, that all statements contained in this apphcohon are true to the best of h~s knowledge and behef; a tk, ar the work will be perfor~ m the manner set fo~h m the application filed therewith. Sworn to befor~ e~ me th~s ~ ................... o, .............. ~ ..... ~~j~~ ~nature of applicant) NOTARY PUBLIC, S~.te of New Yor~ No, 52.452202~ - Suffolk Courtly