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Home My WebLink About9208-z FORM NO. S 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) N° 9208 Z Date ...........................Apr L.......26..... Permission is hereby granted to: .!r Jrosfc.,Fptic4..q9..... Necullouo ...............Hawtuak......................................... . ................................................................................ to .... viot..and..aai>e"In..r"r--yard...�enaiat ay P111` a�Pllestlt►s iF/4 {�j� ................................................................................................................................................................ at premises located at ...1A.X&jx..Aoad......................................................................................... ................................................llat14t=k....X*Yo............................................................................ ................................................................................................................................................................. pursuant to application dated ............................4rJ1....13....... 19..'J..7 , and approved by the Building Inspector. Fee $..1,5&00.......... t �-- G.n. ........... ... .......... .................. Building Inspector FO~LM NO. 1 TOV~N OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. ¥o 19 ........ Permit No ................................. Application No ............................... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS o. Th~s application must be completely filled in by typewriter or' in ink and submitted in triplicate to the Buildim 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 premmes, relahonsh~p to adjoining premises or public streets oi areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which ~s part of this application c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of th~s application, the Building Inspector will issue a Building Permit to the applicant Such permn 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 A/bADE to the Building Deportment for the issuance of a Building Permit pursuont to thc Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicoble Laws, Ordinances o, Regulations, for the construction of buildings, additions or olterotions, or for removol or demolition, as herein described The opphcont agrees to comply with oil applicoble laws, ordinances, building code, housing code, and regulations, ondt¢ odmit outhorized inspectors on premises and in buildings for necessary inspections. · % (Signature of applicant, or name, if o corporation) ~ ...~.~e ..... ~ k~..~.~.~.~, ~...~ ~...~..... ~.~9~2 .............. :., (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...................... ~~ .................................................................................................................................................... Name of owner of premises ~...~.Q~.~..~[[Q~. .............................................................................................. If applicant is a co~orate, signature af duly authorized officer. .......................... 3.,...~a~.~%.~g=a ................................. (Name and title of co~orate officer) Builder's Lic~se No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1 Locohon of land on which proposed work will be dane. Map No ..................................... Lot No ........................ Street and Number }[~[~..~,.~...~.~.~.[.~.~g~e...~-...~.,...~[~ ................................................................... Municipali~ 2. State existing use and occupancy of premmes and intended use and occupancy of proposed construction: a Exisiting use and ~cupancy ..... g~a.~[~..~[[[~ .......................................................................... b. Intended use and occupancy ..... ~e--~...~e.[~[~D ............................................................................. 3. Nature of work (check which apphcable) New Budding ................ Addition ............... Alteration ............. Repair ................. Removal ................. Demohhor .................. Other Work .... . .~..q.~..q .~.~g_ ............................ (Description) 4. Estimated Cost .. ~ 3. .8. .~. . ,. .0. .q .................................... Fee ...............,~..~.~ .Og. ........................................................... (to be prod on filing this apphcation) 5. If dwelling, number of dwelhng units ...................... Number of dwelling units on each floor ......................... If garage, number of cars ................................................................................................................................... 6 If business, commercial or m~xed occupancy, specify nature and extent of each type of use ......................... 7 Dimensions of existing structures, if any' Front ...................... Rear ................................Depth ................... Hmght ........................ Number of Stories ........................................................................................................... g~mens~ons of same structure with alterations or addmons Front .................................... Rear ........................ Depth ............................... Height ...................... Number of Storms ................................ 8 g~mens~ons of entire new construction: Front .................................. Rear ............................ Depth ...................... Height ............... Number of Stones ........................................................................................................ 9 S~ze of Jot Front ....... ~[lg.! ................................. Rear .... '15ClI ............................ Depth ...... '1'~..~! ................ 10. Date of Purchase ................................................ Name of Former Owner ....................................................... 11. Zone or use distr,ct in which premises are situated .............................................................................................. 12 Does proposed construction violate any zomng law, ordinance or regulation ........................................................ 13. W~ll lot be regraded ........................ Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises ~,...~.O.~t'),..~¢.C~P~.QI.lgJl... Address~l~.;L~..]~d.o .............. Phone No..~.~..8...-.~.~..].. Matt~t~ck, NY Name of Arch,tect ............................................ Address ................................Phone No ...................... Name of Contractor ...................................... Address ................................Phone No ....................... PLOT DIAGRAM Locate clearly and d~stmctly all buddings, whether ex~sting or proposed, and indicate all set-back dimensions from property hnes Gwe street and block number or description according to deed, and show street names and indicate whether interior or corner lot STATE OF NEW YORK. ~SS COUNTY OF ~g~,,.,e..g~ ... ................. ~.,.....~..e...~..~...~..~...o.~.e. ........................................... be,nD duly sworn, deposes and says that he ,s the apph.coni (Name of individual s~gning contract) above named He is the ........................... .q..o..~. ~,&~.~¢~. ................................................................................................................ (Contractor, agent, corporate officer, etc ) of sa~d owner or owners, and ~s duly authorized to perform or have performed the sa~d work and to make and file this application, that all statements contained m th~s apphc~t~on are true to the best of his knowledge and belief; ~nd tha~ the work w,II be performed m the manner set fo~h in the apphcat~on filed therewith. Sworn to before me this · ~~~~~,~ .... o, ...... ............. , ~~~~N°ta~ Public,. ................. ~.~. ~. J.~ ..... Coun~ . ..:. ~ture"~of appl,ca~[~' ........................ ~ ~LIZAB~H AN~ N~ILLE ~ NOTARY PUBLIC, Stsle oJ New Yo~k No 52 812585D, Sullolk Cou~.~ Term Expires Mar~h ~, ]g~