HomeMy WebLinkAbout9419-z G F t rv
~ i $
~i i iF ~Kt i d ~3~ 1"T' k' l' Y
i 3 ~ Sk YY ~ W 'A i t
<d f
k ~ rv t d
1 ~ Tsai FORM NO ~e ~ ~ c a { ~ ~ w
g^'- , ~ i 3
TOWN OF SdU'Hdli~ hT ~ ~
BUILDING DEEARTM~ T ~ „ ~
TOWN CLERK'S>bFpIE~~t
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N° 9419 Z Date .........................s111~............?~......~ 79.
Permission is hereby granted to:
f.Y'~;nxX 6.ijt.2,P~ SRI~.'I:~1
Tiuntin~ton
;.;.~:t ~icu=, 7.rt,,;.iri lii't E~ncin~ ~s...^`:.:"..~".',?J.....~1??/7i
to
s T,~v~,> ;~trFet
at premises located at .:1
~x~i~rt
~
pursuant to application dated .............................~~7~•.....`:2......:..., 19.'..~..., and approved by the
Building Inspector.
Fee $ $
} • w.. o..•
_Buildingacssppctor,
r
F'
I
'
~ _ ~ . d
R , y
L
O ~ ~
t
' r ~
~
r
e
0
i I
i { '
try ? G .CS S ~ ~ i
~
j ~ I i~~
!c
I V ` ai
~ L
- ( t ~ ~ Q
~ ~ I
~ ~n,
rc ~
< t` I
< . ~ U, i ~
5• a~°47'oo'W.
p~ /94. 76 ~
~ /f, /gyp ~ '7'C' ~ I ~
~ SUR1/EY~~p ~Gf?
T
DR /E/i,i T N. Y .
C~u~~Grv%a~-fF~~c? ~ .t~~e /~drr;~C
Ar~u. iz,a.~z sy.~'~. V r, T~f/or;~' .:4
iZ . V~,..._~'i
re~~~;fa.,--~, Neu,-
s
i
i t
N
k
x
r+oaat xo. r ~ P ~
TOWN OF SOUTHOLD
BUILDING DEPARTMENt G;~~
TOWN CLERK'S OFFICE
50UTHOLD, N. Y.
/
Examined 19..,../. Application No....~.l~.l~..............
MProved ~:.......:J..r.:...., 19..1.E Permit No..f ..C...~A....:...:............
Disapproved a/c ...r-:7........................... ~--Zr-----------
' 4 r......................
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date ......................:.1t1{ylst.....?.2., 19..~t.`J......
INSTRUCTIONS
o. This 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 showing location of, lot and of buildings on premises, relationship to adjoining premises or public streets or
areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part 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.
TS'~ignature of applicant, or name, if a corporation)
(Address of applicont)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
owfiei~'
Name of owner of premises ...t't~'•~l'itkY'..+U...1,•tv:;E'j...;.,ri1'•,:p,}t
If applicont is a corporate, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No. .i.~~~.~.~neQ.~...k'ei~zCg.(.f~b.).....
Plumber's License No .
Electrician's License No .
Other Trade's License No
1. Location of land on which proposed work will be done. Map No Lot No....................
Street and Number ,
ti~~t...~i•.1.1T!J...:~'L7.'C+r.^~..........f.:C'13iS~.....li"i «t.~ .
Municipality
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Exisiting use and occupancy ...:T.~r2.d1::'L"...],C7:L
b. Intended use and occupancy ...ij,{•,~~...4Yi~'~>•rf
i "s . .
- i
3. Nature of work (check which applicable): New Building Addition Alteration .
Re air Removal Demolition Other Work ....~&Yt~:l-Xig...........................
p
(Description)
4. Estimated Cost ...............~~7..'F';................................Fee ..9.5...Q~............................................................................
r.• (to be paid on filing this application)
5. If dwelling, number of dwelling Lanits ...............Q........:.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
Fleight Number of Stories
Dimensions of same structure with alterations or additions: Front Rear
Depth Height ............................Number of Stories
8. Dimensions of entire new construction: Front Rear Depth
I-leight Number of Stories
9. Size of lot: Front ~.QQ Rear .......:)flO............................ Depth ....:(.~j.~.$~~.~){,yrr..
10. Date of Purchase ........................................................Name of Former Owner
11. Zone or use district in which premises qre situated ~!.~,!!••C13~s•t••••••••••••~•••••••••••••••~••••••••••••••••••••••••••~•~•••••••••••••••••~~
12. Dces propased construction violate any zoning law, ordinance or regulation:
13. Will lot be regraded ......gyp,,,,;,,,,,,,,,,,,, Will excess fill be removed from premises: ( )Yes ( ) No
14. Name of Owner of premises •~ptuY.. LL~:.••]•}d•Le~1•••t~fst~.~i;•h Address ..1.).~~;.).ptv{;•p~•••••• Phone No
Name of Architect Address Phone No.......................
Nome of Contractor ..;a7.'ut-airklCad..a'%i..t:e Address Phone No.......................
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions frorr~
property lines. Give street and block number or description according to deed, and show street names and indicate
whether interior or corner lat.
i
i
I
Sl"ATE OF NEW YORK, t S.5
COUNTY OF ..$~~;~.ga1k•~•••••••••J
•~••••~•••.•.~•••.~~••~4Pt121dr••~iFfl1•'Gkt••••••••••••••••••~••••••~••••••••••••••~~~~being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above Homed.
He is the ...................................0:4ItJ.g~..................................................................................................................................
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or hove performed the said work and to make and file
this application; that all staterr~ents contained in This application are true to the best of his Knowledge and belief; and
than the work will be performed in the manner set forth in the application filed therewith.
Sworn to before me this ~ ~ )
.......,..'a',p....... day of. ...41A ~ aJ i ~k. i
v ~ 1~............~.........................~~`..~........:~:............................
~ ~ ~~Y s
Notar Pub ' ~ Co,un I 'Signature of applicant)
M Q. DAWS4N
NOTARY P LIC, State of New York '
No. 524643721, Suffolk~~
Term Expires March 30, +i.:.Lg '