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Home My WebLink About9290-z · FOEM NO. 2 TOWN OF SOUTHOLD BUILD!HG DEPARTMEHT TOWI~I CLERK'S OFFICE $OUTHOLD, H. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COJVtPLETION OF THE WORK AUTHORIZED) N? 9290 Z Permission is hereby granted to; . · . at premises located at J~l~i{~l..~ii....~- .............................................. · ~'~eal~ ....... --,,z, ........................... ~.:..: ............................... , ........... ................. _ ......... ~. ~ ,~2~ -;~- ,~:?~ ,~..t~ · ·.,...~..,....~ ....... ~,.~....~.,,~... pur~ggn; ~ application 'dat~ ...... ,. ........ ~ ......... Z~..~':i ...... ;::.., i'5;~., and apDrov~ by the DUUU~ng ,nspector ..... - ~ ~ , Fee SLt~.(t .......... Examined Approved FORM NO, ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ...... Application No...f..~...?...~ ............. Disapproved a~ ~.,.~ _~.~~ APPLICATION FOR BUILDING PERMIT Date ......................... ~t3.t'z~...6.s ....... , 19...~.~. .... INSTRUCTIONS o. 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 to schedule. b. Plot plan showing [ocohon of lot and of buildings on premises, relohonsh~p to adjoining premises or public streets or areas, and giving o detailed description of layout ofproperty must be drawn on the diagram which is port of this application. c. The work covered by this opphcotion may not be commenced before issuance of Building Permit d. Upon approval of this application, the Building Inspector wdl issue o Budding Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e No building shall be occupied or used in whole or in port 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 o Buildmng Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o, Regulations, for the construction of buildings, additions or alterahons, or for removal or demolition, as herein described The apphcont agrees to comply w~th all applicable laws, ordinances, building code, housing code, and regulations, and tc admit authorized inspectors on premises and in. buildings for necessary inspections. ...T.~ ~..F.Q,~K..FEN.C~...G D...,....INg .................................. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ......................................... g.~3.~. ~,0.I~ .~. ............................................................................................................................. Name of owner of premises .... ~.~D~.g~...~.ab_"Lz3.~. ..................................................................................... If apphcant ~s a corporate, s~gnature of duly authonzed officer. ........ .s...... me .................................................. (Name and title of corporate officer) ~.~ ~,~'~- V~ '7'/ Builder's Lic~se No .......... i.(..:...~....:.J~..k .................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1. Location of land on which proposed work will be done Mop No ................................ Lot No ....................... Street and Number ...~0..~u.td:Dzx.~.lace.~..R,~ez~po.~t.s...~T.~...¥.~...~,,l.9J, l~ ............................................... Municipality 2. State exmting use and occupancy of premmes and ,ntended use and occupancy of proposed construction: a Ex,siting use and occupancy ....o..~...e..-.~..~..~.Z.~.....c]..w.e..]..].~.gg ............................................................................. b. Intended use and occupancy ....°..~..e...-.~..~....~.]r.~....ct...w..e...1..]=~..z3~. ............................................................................. 3. Nature of work (check which applicable). New Building .................. Addition .................. Alteration ......... Repair .............. Removal ............ Demoht~or~ ............ Other Work f~.rJ~i):).g ......................... (Description) 4 Estimated Cost ...~.~.~../&.,..0..0.. .................................. Fee .............. ~.:I,,~.AQQ .................................................... (to be pard on fihng th~s apphcat~on) 5 If dwelling, number of dwelhng units ........................ Number of dwelling 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 ......................... 7 Dimensions of ex~stmg structures, If any Front ..........................Rear ................................ Depth .................. Height ........................ Number of Stones ....................................................................................................... D~mensions of same structure w~th alterations or add,hens Front ................................... Rear ................ Depth ............................... Height ......................... Number of Stories ............................. 8 D~mensions of enhre new construction' Front .................. , ................ Rear ............................ Depth ................. Height .................... Number of Stories ...................................................................................................... 9. Size of lot: Front ......... ;]r.0.~.! ..................................... Rear ........l~0.! ....................... Depth ....1,~.Q.t. ................ 10 Date of Purchase .................................................... Name of Former Owner ...................................................... 11. Zone or use district in which premises are situated ............................................................................................. 12 Does proposed construchon violate any zoning law, ordinance or regulation' . ....................................................... 13. Wdl lot be regraded ........................... Will excess fill be removed from premmes: ( ) Yes ( ) No , 50 Sutton Place ~7~,-0180 14 Name of Owner of prem,sesG.~.Pr E.~...S.9,]?,~,~0. .................Adaress Gz, e.e.n~:).oz~b~...N~ Phone No ................... Name of Arch,tact ........................................... Address ................................ Phone No ...................... Name of Contractor ...................................... Address ................................ Phone No ...................... PLOT DIAGRAM Locote clearly and d~stmctly all bu,ldmgs, whether ex,sting or proposed, and indicate all set-back dimensions fron property hnes G,ve street and block number or descnpt,on according to deed, end show street names and ind~cat:_ whether interior or corner lot STATE OF NEW YORK. [ ¢ S COUNTY OF ~.C;('O.~ .............. .................... ~.,...P.e~:L¢.oz).~ ............................................ being w n, deposes and says h~t h is the apphcam (Name of md~wdual signing cbntracf) above named He ~s the ................................. .g. QAt~'.9,r~.~..O.~' ......................................................................................................... (Contractor, agent, corporate officer, otc ) of sa~d owner or owners, and ~s duly authorized to perform or have performed the sa~d work and to make and this applicahon; that all statements contained ,n th~s apphcot~on are true to the best of his knowledge and belief; an[ tha~ the work w,ll be performed ,n the manner set forth m the apphcation filed therewith. Sworn to before me this ....~~ .... .......... day of ............. ...... ,7. , Notary Pubhc, . ................................. .~/..7..R./.Z)~. County .~ ' '<' ture of apl~ii~')' ...................... I']O'fARY PUBLIC, State o No 52.8125850, Suffolk Cou~¥,~ :[elm gxp~re.s Mar_ch 30, ~9,~7_"~