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Home My WebLink About9532-z FO~M NO~ ~ BUILDIH~ Dr~AItTMINT 'TOWN CLERK'S OFFICE SOU?HOLD, N% Y. BUILDING Ff, RMIT (THIS PERMIT MUST BE KEPT ON THE I:~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 9532 Z Date ............................... ~O~. ....... $ ......... 19..~?.~. Permis~iofl is hereby granted to: ........ ~Gm~..~,VG ....... gGt~,m~ ..................... to ~eet"~~&G~`~$~6~£~A~G~.~d~s~e~u~d~h~ ........ ....... ~~..~r..~..~.~..~..L.~~..~....~..~..~~ ) at pmmJ~ I~ ~ ...~/~..~..~e~.~..~ .................................................................. .................................................. ~v.C~.....~,.~, .......................................................................... pu~nt to a~[J~J~ ~t~ .............................. ~..~.~ ............. 19.~.~.., a~ ~p~ ~ ~e BuJldi~ I~r. Fee $.J.5;..02 .......... FOBM ~O. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. ,~oproved ~ ~ ~?~ 19 Permit No ....../. .. /?... . .~ .......... ~. Disapproved a/c ..~ ...................... ~--~. ................................... ................................ ............................... AP~UCATION FOR B~ILDIN~ INSTRUCTIONS a. This application must be completely filled in by typewriter o~ 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 showing locationr of Iot and of buildings on premises, re!ationship to adjoining premises or public streets or areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is port of this application. c. The work covered by this application 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 applicant. Such permit 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 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 the 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 to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder~ contl-aet o~' ........................... Nome of owner of premises If applicant is a corporate, signature of duly authorized officer. ~. Pe~.cone (Name and title of corporate officer) Builder's License No ..............~..,.L~.,,.¢ .......................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... kz/' /,/~ 1. Location of land on which proposed work will be done. Map No.: ............................... ./...x~.. Lot No. ( ....................... Street and Number Ttt~. ~7~, ~h*e~n3oo~t,~ ~1. ~, Municipali~ 2. State existing use and occupancy of premises and intended use and ~cupancy of pr~osed construction: c ~P~Ou~ $ a. Exisiting use and occupancy " ~ 4,~,~ .................. . . . b. Intended use and occupancy ................ ~ Nature of work (check which applicable): New Building'. ................. Addition .................. Alteration~. ............... Repair .................. Removal .................. Demolition .................... Other Work ...f...e.~.9..J:tl.l~ ............................. .... (Description) 4. Estimated Cost ...~..6....0~...:..0...0. ...................................Fee ...... ~..~..*..0.0. ..................................................................... (to be paid on filing this application) 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, Dimensions of existing structures, if any: Front ............................ Rear ................................Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................Height ............................ Number of Stories ................................ 8. Dimensioas of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ..................................................................................................................... 9. Size of lot: Front ...~.~....O.~..~.]....e. .............................. Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................Name of Former Owner ........................................................ I I. Zone or use district in which premises ore situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded . ........................... Will excess fill be removed erom..pr~mis~s: ( ) Yes ( ) No 14. Name of Owner of premises .}'l.~.~..~.3.?..rl....,l~.,~.~.~,.°..~.. .................. Address t~.g.t~.~.~ll*~{...Ixl~... Phon* No ....................... Nome of Architect .............................................................. Address ................................Phon~ No ....................... Name of Contractor · ............................................ ~ ............Address ........... Phone No ...... ~f ........ Locate clearly and dis~inctly all buildings, whether existing or proposeql,~nd indicate all set-back d nensions from property lines. Give stree~ond block number or description according t/~--dt[ed, and show street nam~ and indicate whether interior or corner I STATE OF NEW. YOI]I~.. ~ S S COUNTY OF .,~.~..~],~:'.?.~.[~. ............. )' ' .............................. ~.~.,.~,~,~,~ ...................................... being duly sworn, deposes and says that he is the ~pplicam (Name of individual signing contract) ~bave named. He is the ............... .9.g~.~.~ ......................................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and tha~ the work will be performed in the manner set foffh in the application fAled therewith. SwofnJ~fore me this ~/ t ~ ~ // ~ ~ , ........................ oOy o~ ............. .h............' ................ ~, ,,.-~. ~// z/ 7 / ~ ,.S,,.. . .................. ........ : ............... ~q/~ ' '/ '~ ~g ~ ) ff~ Y /(Signoture of applicant) NOTARY PUBLIC, State of NO~ York No, 52-8125850, Sullolk C~ ~tm ~xpiros March 30, 1~