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Home My WebLink About9513-zTOWN OF SOUTHOLD BUILDIHG DEPARTMIHT TOWH CLERIC'S OFFICE SOUTHOLD, H. Y. BUILDING FERMIT (THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL COMPLETION Of: THE WORK AUTHORIZED) N? 9513 Z Permission is here~y granted to: ....... lla~.t £ta~lc ................................................... to ~;~..~:~...~mXuLa:L~..£~n~.~.g.. &z...p~...app3J.~l.c.~..~Zl.0~ ......................... at premises loc~ed at ......~.~...P..~..~...h. ............................................................................................. E ~ rio ]~.Y ................................................... ~....~ ....... G ........... .~ ............................................................................. pursuant to application dated ............................. ...O~.~...1.Q ............ , 19~.7...., and approved by the Building Inspector. Building Inspector TOWN O~ SOUTNOLD BUILDIN~ DEI~ARTMI~NT TOWN CLERK'S OFFiCI~ SOUTHOLD, N. Y. Examined J') 19. Approved ................... 4 ...... ...~....~....., 19.../..Z. Permit No.../. .......... ; .................... Disapproved a/c ~7~ ......... ~~~.~-~I.~ (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No. INSTRUCTIONS Date , Octobez, la; ]9.,.7.Z ..... o a. 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 .t~ schedule. b. ' Plo1 plan showing location of lot and of buildings on premises, relationship to' adj~oining premises or public streets m areas, and giving a detailed description of layout of property must be drawh on the diagram which is part of this application. c. The work covered by this apl~lication may not be commenced before issuance of. Building Permit. d. U~oon~approval of this application, the Building Inspector will iskue a Building Permit to the applicant. Such permit shall be Kept on the prem ses ava lable 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. ',~PLICATION IS HEREBY MADE to tl~e Building Department for the issuance of a Building Permit pursuant to the BuilSing Zor~e Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lows, Ordinances or RegulatiOns, fOr the construction of buildings, additions or altm'ations, ar for removal ~or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, buildi~ig 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) ...R. %9..,....2..~(~..,...~.~..~.~ ~.~..c. ~,... ~., ...¥.,... L .1.9. ~.~ ......~. ........... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, gan'oral contractor, electrician, plumber or builder. c ant ~act or : ...................... Nome of owner of premises ....... ~.~..9~,~...,~.0.~.~;.~ ........................................................................................................... if bpplicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) -Builder's License No. ~ ~ F~' 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 ......................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy one-fa~il.-~ .-. .... ./~/~L...: ..... .~ ......... .~ ........................... 3. Nature of work (check which applicable): New Building'. ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ....~..e...n.9.,i..~.~ ............ "......i .......... ..., (Description) $36 .0o 4. Estimated Cost ............................................................ hoe .......................................................................................... (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. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ..................................................................................................................... 9. Size of lot: Front ......... /~..~.D..'.~....'T.. ............................ Rear ......... /..-)..Z.(. ...................... Depth ....... ~.~...&.. ....... ~ ......... 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning Iow, ordinance or regulation: ........................................................ 13. Will lot be regraded . ........................... Will excess fill be rem~ed.,frorn,oremises:, ( R)cl.Yes ( ) No ,b,b M a.t~.LDOZ' au ~ t~ 14. Name of Owner of premises ..G..e...o.......~..o..b..m...t.~.~ ...................... Address~.,..~]g~.t~.d...~f]~hone No.~.8..9..';..0.~.3.7. .... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly oil 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 NEW YORK ~ S S COUNTY OF ....~.~..~.;.6.~..~. ........... ~ · ~ ............................ ~.~...~..e...~.?...i..°..9.~.~. ......................................... being duly sworn, deposes and says that he is the applicanl (Name of individual signing contracf) abow; named. He is the contractor (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 knowl,~and belief; and tha~ the work will be performed in the manner set forth in the applicotjpn fi)ed th~rewith,,,~ / ) Sworn to before me this ~, . / __ // // // ,/ / / / , of ....... ................ ....... ......... ~~~, ~ ff (Sig~re of applicant) // ELIZABETH ~NN N~II.L~ ~ NOTARY PD~[I~, ~l~le ol New York/ No. 52'~Z5~0, SOffolk ~o~ Term Exprres ~atch 30, ]9~