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Home My WebLink About11683-zBUILDING DEPARTMENT TOWN HALL SOUTHOLD, N~ Y. BUILDING :PERMIT (THIS PERMIT MUST BE KEPT ON TH,E P~REMiSES UNTIL COMPLETION OF THE WORK AUTHORIZED) F~LL 1~!0, l'l I~ 8 3 Z Date .... ........ .................................... , Permission is hereby granted toA tO .............. -~-..--. ........................ ~ .... , ' , ' . " · ' ..... ~, ............... ? ...................... ' ..............................................................................., ,. , //~ 0 i~2 ~~f~,r'". ~ ,'"'~ ....... ; ............... ~.!" .... at premises locatea at ............................................ ~~, ............... . .............. .~ ......................... ....~1~ ~? ............................................... ~ ~-J~.~t/ ~.'.~'"" "~'"; 'i ~'~"*'"'?'"~: ~' '.~.~'"~'"'~ ....... ~I~, .~.~'''' ? ............. ~iii~' .......... ................. ~ ............................... ~. .......... ~.....~........~....... .......... ~ . ~t...~jf~...~ ..... ~.~ ...... ~ ........ .~... Cou&ty Ta~< Map No. 1000 Secton ......'~..,./ ........... .'; Bj,ock .,,¢...,.;; ........ Lot No......'/...:.. ............. ; 7~ '~t ~" ~"' ~ · the pursuant ~o application dated ................................ !',~'~'~';' ";'i~'"', 1Eq"i "~ ana ~pproved by Building I!~ector. Fee ~..'. .................... Approvcd BUILDING DEPAFI'FM ENT TOWN HALL SOUTHOLD, N.Y.. 11971 TEL.: 765-t802 FOR ,t NO. 1 T~,~h~ C? SOUT:4OLD 19 . . . Permit No ............ 7 Disapproved a/c ....... ; ....~ .............. '. ~ (Building Inspector) APPLICATION FOR BUILDING PERMIT ppucauon mo. ,. ............ ~ Date ............... ?9 INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buik Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Pies plansao~ ,.wno~, location of lot and of buildings on premises, ~elationship to adjoining premises or public str or areas,, and giving a derailed description of layout of property must be drawn on the dia~am which is part of'this c.'lheworkco~ered oytMsapplicationmay o, becomrnem, edoefm~;issuanceofBuUding d. Upon apprc.'al of this application, the Building Inspector will issue a Building Permit to the applicant. Such fez shall be kept on the premises available for inspection .throughout the work. e. No buildiug shall be occupied or used in whole or in part for any purpose whatever unti/a Cexntificate of Occt~pa shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance ora Building Permit pursuant to Buildino. .... Zone Ordinance of the Town 'of Southold, Suffolk County, New York, and ,- **,~'-,.,.. appl....a~,~;, ~'" ,-~a~,s,r ...... ,~,m ~a',~t.~:- - Rc~u.~ ,~ ... constructior of buildings, additions or alterations, oz' for removal or demolition, as herein descril TEe applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regularMi,a, admit authorized inspectors on premises and in buildings for necessary fnspections. _(Si,~'ffature of apl~Iicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, ~rc'fitect, engineer, general contractor, electrician, plumber or bull. Nane of owner of premises . .. 1 ~-~ .... .,~ ./J,5'.. Z4-] .~ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer') .... '~.,i3C' Builder's License No. Plumber's License. No ......................... ectr c a 1 s L ccnsc No ....................... Other Tradc's License No ...................... 1. Location of land on which proposed work will be done ............................................... ..... 1. . ............... O /:. cxi . . ......... . . . House Number Street Hamlet ...... County Tax Map No. ~000 Section (~ :h Block .~ Lot. Subdivision ~ ~.i~' ~. · .~ ~.~ .~ ......... Filed Map No .... ~.35. Lot (Name) .......... 2. State existing use and occupancy of premises and intended us~ and occupancy of proposed construction: - a. Exist nguseand occupancy .. ~ ~ ~ ~r~O~ Nature of work (check whicl,, applicab,'Je): New Building ......... Addition ...... k' ' · Alteration ' ', .... ', · .............. . i ........ .. V,',mo it/on .... · .......... O ,',er .4ea . .' · ~i = (Description) Est~a~dCost rS' ' ,c~O [ ,: ..... 15'....O..0.. ....... ......... t ...... , ...... 1 ................. fee [ (to be paid on filing this application) It' dwelling, mlmber of dwelliag unitsl ........... Number of dwelling units on each floor .............. If garage, number of cars ...! ...... If business, commercial or talked occu Dimensions of existing structures, if.a~ Height ............... Number ol Dimensions of same structure;with alt, oancy specify nature and extent of each'type of use .y: Front ............... Rear .............. Depth ............. Stories ...................................................... rations or additions: Front '' Rear pth He " ' ' t Number of Stori,es ,DhnlenslonS ut entire new constructlor 9. Sizcoflot: Front .... (o~'~ ~ . ' .. ~,,.~, (ogt , lt. Zone or use district in which premises hre s tuated ' ~, ':. ' 12. ~oes proposeu constr'dchon VlOlate any zoning law ordl lance or regt at on ................ G. Will !ut be regraded .., .,,,,A-O....i?... .... ['. .............. Will excess fill be removed }ron~ premises: ' x~i~ "~ ~,~,am, o: Arcmt~ct . . ;t .... i': .... :[. ......... '.. Address . .. ................. Phone No ............... Nam e ut Contractor . .~ q,¢A !:q../.t2.}t..{ .4-g,.C.~ .....Address , jk]O ~:p.~P.~' &. ff.d., ~o, Phone No..7. (/.~' r.,~ 1 ~.,%.. ~ PLOT DIAGRAM " k,,,.,,,,,,,,~ .,,es. ,.me street aha moc;~: ntm:ue~r or description according tO deed, and show street names and indicate wheth( ;nterior or corner lot. ' ' .(~'amecCf individual signing conlract)} ~ ........ being duly sworn, deposes and says that he Js the applican above named. e is the . .' ............... ~ctor, agent, corporate officer, etc.) i'.. to perform or have performed the said work and to make and file thi ; t ~;~ s ~ application are true to the best of his knowledge and belief; and that th. Work will be performed in ~ ' tee manner set forth h~ the application filed therewith. ,Sworn to before me this