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Home My WebLink About9964-zN°. Permission is hereby granted to: l~O~ NO. ~ TOWN OF $OU~HOI.D ,' BUILDING i)EPAP~M~NY TOWN CLERK'S ~FICE SOUT~LD,' N~ Y. ~;- BUiLDiNG rpERK41T - (THIS PERMIT gUST BE KEpT O0 ,TH~':P[EMISI~S UNTI~ FULL :L ,. COMPLETION 'O~ ~HE ~RK AO~HORIZ~, ~, ''~ ~ c~t premises located at PUtfuant' t? aP, p!jcatiO?r,. · , / / FO~N~ NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Disapproved a/c ................................................................. 7~ ..................... /// //(Bu{Iding Inspector) APPLICATION FOR BUILDING PERMIT Date .............................................. , 19. , INSTRUCTIONS 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 pier 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 o; areas, and giving a detailed description of layout ofproperty 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 whcrtever until a Certificate of Occupancy 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 the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lows, 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 al app icab e aws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. ~' ~(Signat~e'of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .................................................................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......... ...~...'..'~..~-.~i ...................... Plumber's License No ........ ~..~..~..~...i .................... Electrician's License No ..... ..-~.,.~,/~...~..- ..................... Other Trade's License No ............................................... /J~,<~qc/ ~'g~Z'G//~ l. Location of land on which proposed work will be done. Mop No.: ..... .Z..Z.~9. .......................... Lot No ..... .5.g...,&...5.Z. ...... Street and Number }~ax 53 5te~ling Road Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ........... .A..~..~..~:.c.~.-.~.S..~..~..=...a.~.e.~..~..~/~...~.~..~..~.~`~~:~[~ b. Intended use and occupancy ........... .G..u..e.~..~.ggt~.....~.Z2~./..//~...~.....~..~.~.~..7..,/.~~ .... 3. Nature of work (check which applicable): New Building.. ................. Additio ~.~;¢~,~.. Alteration .......... Repair .................. Removgl .................. Demolition .................... Other Work .................................................... / / ~' (Description) 4. Estimated Cost ......... -~2'~'~"-2 L ~"~...~.~..~-~...~.....2.'i.'i...Fee..,../....~....~..~,: ....................................................................... (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 ...........,2 ................................................................................................................................ 6. If business, commercial or mixed occupancy, ~pe~cify nature and extent of each type of use ................ 7. Dimensions of_existing structures, if any: Front ............................ -- Rear 24' Depth 24' ............ Height 17' Number of Stories attic Dimensions of same structure with alterations or additions'. Front ........... ~.4. ..................... Rear ...... ;~.4 .................. Depth ............................................................ 24 ' Height 22 ' Number of Stories ................................ 2 8. Dimensions of entire new construction: Front ........ 24?. ...................... Rear ..... ~.4 ................... Depth ,,,,~ Height ....... 2,?,! ........ Number of Stories ...............2. ...................................................................................................... 9. Size of lot: Front .................. I~Q! ................................. Rear ...... B.Q! ............................... Depth ..~,~R~.! ...................... 10. Date of Purchase ................ ..1:.9..4.~ ................................ Name of Former Owner ...~.~.~,cl. ........................................ 11. Zone or use district in which premises are situated ...................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .... .N.~ ................................................ 13. Will Iot be regraded . .......N..a. ................. Will excess fill be removed from premises: ( ) Yes (x) No 14. Name of Owner of premises ...L.p.~.J,~...G..u.,$.,d. rq ............................ Address ...5..3....5..¢..R~.'[.~.n.g,...R..d... Phone No...7..3..4.~.5.,2.,q,1. ..... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all 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 interleaf or corner lot. -; ,' .~._. S1-ATE OF NEW_YORK ~SS OF ......... ............... ~'..~...~......¥..~.....'~?,,-L~..~.J~ .................................... being duly sworn, deposes and says that he is the applicanl (Name of individual signing contrad} above named. He is the ................................ ..~....~...-~....~-- ....................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove 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 knowledge and belief; and tha~ the work will be performed in the manner set forth in the application filed therewith. Sworn to b_~fore me this ~., ............ ...... day, '----' '-'-- ............. , - · ~ . Nota Pub,c, ................... Cou, ...... ............ ....................... ,~ ~lj~ature of applicant) / ,~ ,~ BABETTE C. COI~I~ /2 ~ .~/1~.~ ~ · ! I~IOTARY PUBLIC, ~t~te o~[ New Yo~'k Suffolk County No. $2-57928§~ ~.-..~'-~' ~--' c~ Commission Expixe~ M~rcl~