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Home My WebLink About9495-zBOIi~DiNG TOWN CLERK's OFFICE SOUI'HOLD, N.. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 9495 Z Permission is hereby granted to: A., ~. ,.Ga~.~....~.o.~i...~.~r.,~;r...~.~... A/~...E..~ .~I. ,... ~.ar ~e nte ~' il at premises located at ..~;J,g.~l~..39.....l,O.%...5~f). ......... P.~:~...It~,.(~ .................................................... ........................................ ~he.~ l~ ~mt s .................. pursuant to application dated ................................ 8~p.t-...'.3~ ....... , 19...~.~., and approved by the Building Inspector. Fee $.15,g.~ ........... t TOWN OF SOUTHOLD BUILDING DEPARTMINT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ~ / ............................... I ....... . Approved ............... ~..l .......... l./. ...... , 19.7....~.. Permit No ...... .?........~.....?,..~.~....~..... Disapproved a/c ............................................... ~ ~ ................................................ ........................ INSTRUCTIONS Application No ......................... .... a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Building Inspector, with 3 set~ 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 prem ses or publ c streets o~ 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 Build!ng Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspechon 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. '~~ applicant, or name, if a corporation)f~ ..... ~0.~.~ ~7~ I~L~o ~ ~ o ~ ............... . ......................... .~ ........ :~ ........... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..L~....~..;....~..~...~.....~.....~....~...~.....~.~..~.. ~ ..................... If applicant is a,cor~orate, signature of duly authorized officer. /. ........... ...... ...................... ~ame and title of corpo~.'6te officer) Builder's License No. -'~ Plumber's License No. /-~L/~- Electrician's License No. ~-cl ~ - F~ Other Trade's License No. - -I. 1. Locotion of land on which proposed work will be done. /V~ap No .~..~....~....~....~...~.~. .............. Lot No.E...°~. Street and Number ~LocI~ ,~ t~ ~.~..~ J,..~Lo~[~ ...... Municipality 2. State existing use and occupancy of premises and intended, use and occupancy o~ proposed construction: a. Exisiting use and occupancy , .l~.~.i ~...~.., + ~ c~ L b, Intended use and occupancy ...................................................................................... 3. Nature of work (check which applicable): New Building'. ................. Addition ....~. .......... Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ................................................ . .... (Description) 4. 'Estimated Cost ....~.~.~....~.K~..,...~.~... .............................. Fee ...... ./.~. ................................................................................ (to be paid on filing this application) I u 5. If dwelling, number of dwelling units ............................ N mber af dwelling units on each floor ..../. ...................... If garage, number of cars ....~..q4Z.~, ............................................................................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ........................... O 7. Dimensions af existing structures, if any: Front .I.~....~...~ ....... Rear ..5..~.; ...................... Depth ...I ................ Height ..../...O..~. .............. Number of Stories .........../. ................................ .; ................................................ ; .................. Dimensions of same structure with alterations or additions: Front .~..Q.. ......................... .... Rear ..?...At:.. .................... ,,~zf,' He ht /~: Number of Stor es ./. : ............... Depth ................................ g .... , ' 8. Dimensions of entire new construction: Front ....~...Q.. .......................... Rear .....?'....~..~ ............... Depth .../...~...~ .............. · / Height ./...0. ............. Number of Stories ............................................ :F ................................................ ¥ .................... ....... ~ ,/~O? e_ Rear .5'.~ '- Denth ~O~- 9. S .... f Irt: F ........................................................................................... :~'~' ......... r~' ................................ 10. Date of Purchase ".~..0..~:...I.~..~....';~, ............................. Name of Former Owner ..~'.,..!;.....~..~..~.~...e...~. ........................... 11. Zone or use district in which premises are situated ...~.....O~......~...i~.~ ............................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... ~.(R. ............................................. 13. Will lot be regraded ...~...O. ..................... Will excess fill be removed from premises: ( ) Yes (X) No 14. Name of Owner of premises ~.g..~.-J~ ........ Add ress~o~ .~-~ .~<~J~..~-~..... Phone Name of Architect~..H.~.i~.-I.~..tD~:S.~..S.~.~.}R~ ...............Addressg..G~[.~.~,.~.~9..~ ..... Phone No.~.....~'.~?.~....q~..( Name of Contractor~.'..~.o...~.~..~..~...q~.~....'..L..~i~,l~,l~~-.. Address~-.'~..\.G....(~......k)~.. ..... Phone No.q...~t..~.-I..~.( ..... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF N~ [,S S COUNTY OF .....~.....'~...'..'. ................ ~ ' ..~.~..~ll~..~Ii~k.~J.~.t ............................................................ being duly sworn, deposes and says that he is the applicant (Name of individual signing contracf) above named. He is the ...... ~ ............. IIl~II~ ........................................................................................................................................ (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 that the work will be performed in the manner set forth in the application filed therewith. Sworn to. b.efore me this' '; 't-&~ '~' ........ ........... day of ...... ................. , _ Notary P u b I ic ,'~2,44,x~, .J~. ' .J'~....~.~....~ .. '~L' ~J[~L~OU n fy ~"'" '~'"~ ...... ~ '"' ~l'i'~:'";)' ............................. · ' .... O .... ~ Il ~ (Signarure o alSplican ) MARY J. PANKIEWIC ;Z NOTARY PUBLIC, STkTE OF NEW YORK NO. 52-1267950 - SUFFOLK COUNTY COMMISSION EXPIRES MARCH 30, t9-,~' I~-ocJ( '~D Lo'r(-,, - FL 0 0 ~ PL/kM-