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Home My WebLink About9278-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 AUTHOi~IZED) N? 9278 Z Permission is hereby granted to: itoU~_~_~_~..~k..~L~t~Le.t ............................. .................. ~ho~ ....................................... ' at premise~ Jocated, at .~J..~F,,~Jir..~J,~,, ....... ~T,e~I~..~tP, JJ~T~J ............................................ ~L~~ ~ · ....... ',, .................. '....~ ..................... ~ ~ .................................................................................... ~. ._ ~ .... : .................................... , ................ : ....................................................................................................... ~j;. =:~:~ pu~nf,lo a~hcat,on dat~ ..................... ~..2 .................... , 1~..., and approved by the TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. June 2 19.77._... Examined Approved ............ J.~ae,.-2- ............. , 19.Z~... Permit No. 9278Z Disapproved a/c ............................................................................................ Application No ....... ~..~..?..~. ............. (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS June 2 77 Date ................................................ , 19 a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildir 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 prem,ses, relationship to adjoining premises or pubhc streets ~ areas, and gwing o detailed description of layout ofproperty must be drawn on the diagram which is part of this applicatio, 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 opphcant. Such perm 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 Occupan, shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment for the issuance of a Building Permit pursuant to Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions ar alterations, or for removal or demolition, as herein describe. The applicant agrees to comply with all applicable laws, ordinances, building code, housing cede, and regulations, and admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if o corporation) Southoid 1,.'I. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde .....................................................t. ................................................................................................. Name of owner of premises ...S..9.~..t.h..%.i..d....,P...a..r..k....?...i.,s...t..r..i. 9..t ........................................................................................ If applicant is o corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ............. .o.~.%:V. ............................ Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... XXX XXX 1. Location of land on which proposed work will be done. Map No.' ...................................... Lot No ..................... Street and Number .... ..~,/..~....~..e.~..~.~. ..... ~..~..e..~...~.f~.L~.:~.~.,%..~g., ........~.9.1~.~.~,9.~,.(], ......................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy af proposed construction' a Exisitmg use and occupancy .... ?..~.~....~..~.°..,R.e..~.~.. ......................................................................................... b. Intended use and occupancy sanle with additional fencing 3. Nature of work (check which applicable). New Building ................ Addition .................. Alteration .............. Repmr .................Removal .................Demolitior ..................... Other Work ..... ~'~Ztl3 ~.tq~ ............................. (Description) 4 Estimated Cost ..............?. ....................................... Fee .~1 ~'o00 (to be pa~d on filing this application) 5 If dwelling, number of dwelhng umts ..... Q .............. Number of dwelhng umts 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 ...~...8...z:.lf:.. ............ 7 D~mens~ons of exsstmg structures, if any' Front ...................... Rear ................................ Depth ................ Hmght ...................... Number of Stones ................................................................................................... D~mens~ons of same structure with alterations or addmons Front .................................... Rear ...................... Depth ............................ Height ...................... Number of Stones .............................. 8 Dimens~ons of entire new construction' Front .................................. Rear ............................ Depth .................. Height .............. Number of Stories .................. 9. S~ze of lot Front ............................................. Rear ........................................ Depth ............................ 10 Date of Purchase ................................................... Name of Former Owner ....................................................... 11. Zone or use d~str~ct m which premises are s~tuated ?!~!!...gLJ..at ................................................................... 12 Does proposed construction wolote any zoning law, ordinance or regulation: ......... Z~f) ......................................... 13. W~II lot be regraded .........~.O. .............. Will excess fill be removed from premises. ( ) Yes ( ) No 14 Name of Owner of premises .... ..~..°..~..?'.h..°.~g....].:?.~...D...z..s..~.z. (A~ddress ................................ Phone No ...................... Name of Architect ..................... Address ................................ Phone No ...................... Name of Contractor ............. $.am.e.. .................... Address ................................ Phone No ...................... PLOT DIAGRAM Locate clearly and d~stmctly all buildings, whether ex~stmg or proposed, and indicate all set-back dimensions fron property hnes Gwe street and block number or description according to deed, and show street names and ind~cat, whether interior or corner lot see attached plan STATE OF NEW ~,Q~d,<, .... ~ S S COUNTY OF .... ~.u...z....k.u.z..~.. .......... Frank Lehich ..................................................................................... being du~¥ sworn, deposes and soys that he ~s the apphaa.~ (Name of ind~wdual s~gn~ng contract) above named. He ~s the ....................... ?..:..r.~...g..9.~-:.~.~.$..s.~.i...o..z.:.,.o..~.~...~T¢ .................................................................................... (Contractor, agent, corporate officer, etc ) of sa~d owner or owners, and is duly authorized to perform or have performed the smd work and to make and th~s apphcatton; that thru the work w~ll be performed m the manner set forth ~n the apphcahon filed therewith. Sworn to before me this .................. .2. .... day of ..................... ~.'~..e. ....... , 19 ~7~. Notary Public, . ........... ~ ............ County ....................................................... : ............................. ap nt) srlUTHOLD PARK DISTRII3T BnUTHCILD, L.I.~ NEW ynRK 11971