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Home My WebLink About9841-z ~O]~,~I NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFICE SOUTHOLD, N. Y. ~ BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 9841 Z Date .......... Jt~'y ........ '17' ....................... , 19...78 Permission is hereby granted to: ~amea & ~n~..!~3~t~.e ..... ........................................ ;...~t~l~ue,...N~.. Y~ ...................................................................... ': ......... ;..hLo~..//....1..~,..ZO..t~..S~b..4 '~97' .... Ad. et,.~ ........... .~....: ......................................................... ~' '~' '..: ........ :~,~.~,....:. ;~ .va :~ I~g?s~ant to application ~dated .~.i;..i.,...i ......... ~ 19. ., and approved by the ~?,:~( :f B~iJding inspector! Building Inspector TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTNOLD, N. Y. Approved ............ JU3.3r......1.~. ........ , 19....'~ Permit No ....... ~.{~.,..1.~.. ................. Disapproved a/c ................................. ;~ ......................................................... ..................... .............. ....................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS 9841 Application No ............................ ~0 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 to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this application. 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 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 part 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 a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described.~ The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. 41(('J' /. (~5j~l at ~:)pl~c~3 iD~or~jlame, it a corporation) State whether applicant is owner, I;see, ~gent, architect, engineer, eneral contractor e ectrlclan lumbe r ~ ~ g , '' , p r O builder. ... o.zed . · .................. ~.;..;;~..;};~;..j.~;7~3.;3.;;.;~¢i~;~i ......... ~ ~&~ ~ ~ . Plumber's License No ................................................. ~1~ Electrician's License No ............................................. Other Trode's License I,J,~ ................................................. 1. Location of land on which proposed work will be done. Map No.: .............................. .~.~ ...... Lot No ............. Municipality 2. State existing use and occupancy of promises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ......~...~..~:~3..~....l...~...l~...~....~....~..~..~...~.9.~.0...u~..~ ........ Q.~.~...~...~..~/Tj~o..Cq ..................... b. 'ntended .se and occupancy i~. 3. Nature of work (check which applicable): New Building'. ................. Addition .................. /// / ,q __ zA~lterati.°n ................ Repair .................. Removal .................. Demolitior ........ Other Work .~'.JC~'.~....~..'/..~,~..~/...~.....~..~//~$~ (Description) 4. Estimated Cost ................................................... Fee (to be paid on filing this application) 5. If dwelling, nu,mber 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 ....... ./.,0...~ ....... Number of Stories ............./. ........................................................................................................ 9, Size of lot: Front ............ .~..~'..~....~............................ Rear ............~...~...~. .................... Depth .....~...~..~....~ ................. 10. Date of Purchase ............../e .......................... Name of Former Owner J i J~JC~ ~J~ J J~:~lJ ................. 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 regroded ..... /~.I). ............... Will excess fill be removed ~om ,premises: (_) Yes (Z~ No ~Y ~1 ,~ iq4 ~g '~:. ~_,Ue~. ~,:~f'-~. !~,~~- j. e No ............. .~...9'...~Z~:~., ~,~.... 14. Name of Owner of premises ...-...~..~....~..:,-.4,~...~./....~.:.:~..~...~,mmdress Nome of Architect ....... ,.t~,.ff~....~........................................... Address ................................ Phone No ....................... Name of Contractor ...... ../~...o..~..~. ......................................... Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions frorn 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 N e,,',C ri4 ,J) / COUN'rv ' ' (~a~ individual signing contrac0 above named. .~.~ ~ .~ He is the .................................. ~ ~ ............................................................................................... (¢ontroctor, 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 applicdtion; that all statements contained in this application are true to the best of I~is knowledge and belief; and that the work will be performRd in the manner set forth in the application filed therewith. Sworn~fore ~this ~~ 2~ ~'~~ Nota~Publi~~, ,~'u................... ~I ~ ............................. AL~ ~ DIC~