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Home My WebLink About9207-z FORM 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) N9 9207 Z Date .........................April.....26.......... 19...?!� Permission is hereby granted to: �.i1a..?r�k..�'�taca..S:a....11/.Clllaa�rsa•��ady' ..................tknitua........................................ ................................................................................ to ... ...................... ................................................................................................................................................................ at premises located at &Q440....X/..ftrSeA.*V*......................................................................... ..............................................lf attituck......Y................................................................................ ................................................................................................................................................................. pursuant to application dated ....................April..••12............... 19.7!7.., and approved by the Building Inspector. Fee $15000 �r Building mn ec or FOn. M' NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOI.D, N. Y. E amined ...... ...... , " .7...7. O-o v z_ ........................................ " , 19 .... Permit No .................................... Approved Disapproved a/c ......................................................... APPLICATION FOR BUILDING PERMIT Application No .... .~.....~...q.,'~ ......... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Build 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 areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of thru applicati c. The work covered by tMs 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 per, 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 o Certificate of Occupa, shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Budd,ng Permit pursuant to Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulahons, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describ The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized ~nspectors on premises and in buildings for necessary inspections. · .T.WI/t..EOP~K..EF.?IQg..O.Q~,...Illg., ........................... (Signature of applicant, or name, if a corporation) (Address of applicant) State whether apphcant Js owner, lessee, agent, architect, engineer, general contractor, eJectmc~an, plumber or bud- ............... c.~r~,~,.~c.~.o~, .................................................................................................................................................... Nome of owner of premises ....l~'g~.~.~zl...?!~l.d~ ............................................................................................................ If applicant is a corporate, signature of duly authorized officer. .......... ~.~..I~. ~.~ ~".f ~.or~. ............................................... (Name and title of corporate officer) Builder's License No ..................................................... Plumber's bcense No. ................................................ Electrician's License No ............................................ Other Trade's License No ............................................... 1. Lecahon of land on which proposed work will be done. Map No.: .................................. Lot No .................. Street and Number ...Dez,~ea..~L~ze.,,..~a,t:~£f;=ctc~..~,...~,...3~%9.~2 ...................................................... Municipality 2 State ex~sting use and occupancy of premises and intended use and occupancy of proposed construchon' a Exisiting use and occupancy ..... o=e...~.a~l,%l~r...d~e]:.].[~ ....................................................................... b Intended use and occupancy...,..i:~t~...fJ~,~'...d~.e,~._~._~.t~ ........................................................................ 3 Nature of work (check which apphcable) New BuHd~ng .................. Add~tton .................. Alteration .............. Repmr ............... Removal ................ Demohtmr. .................. Other Work ..~.~.1~l~J,l~. ................................ (Description) 4, Estimated Cost ..~.~.~.O.0,.00. .................................. Fee ........~.~.,0~ ............................................................. (to be pad on filing thru application) 5. If dwelling, number of dwelhng umts ...........................Number of dwelling units on each floor .......................... If garage, number of cars 6. If business, commercial ar m~xed occupancy, specify nature and extent of each type of use .......................... 7 D~menstons of extstmg structures, ff any: Front ........................... Rear ................................ Depth .................... Height ........................ Number of Stones ............................................................................................................. Dimens~ons of same structure with alterations or addmons: Front .................................... Rear ......................... Depth ............................ Height .....................Number of Stones ................................ 8 Dimensions of entire new constructton Front ..~J~Jll~ ..................... Rear ...... JJ-~L.~ ............ Depth ~,J~[J~ ..... Height .................Number of Stones ...................................... 9. Size of lot' Front .......... .~..0.O..~, .................................. Rear .......2.QB.! ........................ Depth .~.~.0.~.~.t. ............... 10 Date of Purchase ....................................................... Name of Former Owner ...................................................... 11. Zone or use d~stnct m wh,ch premmes are s~tuated ............................................................................................ 12 Does proposed construchon violate any zoning law, ordinance or regulation' . ...................................................... 13 Wdl lot be regraded ........................Will excess fdl be removed from premises: ( ) Yes ( ) No Bergen ~ve. 14 Name of Owner of premises ~[.~?...~..e...~...~..~..a..~. ...................... AddressM~r~tyl..~,,~Cj~..~ .... Phone No. Name of Architect ................................................. Address ................................ Phone No ..................... Name of Contractor ................................................. Address ................................ Phone No ..................... PLOT DIAGRAM Locate clearly and d~stmctly all buddings, whether ex~sting or proposed, and intimate all set-back d~mens~ons rrm property hnes Gwe street and block number or description according to deed, and show street names and indicat whether interior or corner lot STATE OF NEW YORK. lc S ....... COUNTY OF ~B~.~.O.'lk .............. f'~ '- '~ rd' ..................... .~. ?.,..P..e.,~...~..]-...~.9..~..6. ...................................... being duly sworn, deposes and soys thor he ~s the oppho (Name of individual signing contractO above named He is the .................................... .O...O.~.~..~..~.~..O..~.. ............................................................................................................. (Contractor, agent, corporate officer, etc.) of so~d owner or owners, and ts duly authorized to perform or have performed the said work and to make and this apphcation, that oJJ statements contained in this apphcahon are true to the best of his knowledge and belief; , that the work wdt be performed m the manner set forth m the apphcation filed therewith. Sworn to before methis -- t,'~ f ~ bi^ t"'/~ J,_ ~ 7/ r-J~. ~r~¥')'' ~ ...~,~.~...~.[A.. day of ........:~"..prl.t ....... : ....... , 19 NotaJf pub, lc,. .................. Count, ......................... IIOTA~Y PUBLIC, St~te ol NeW ~'or~ NO 50 8125850 Suffolk County Term ~xp~res M~rch 30,~(~