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Home My WebLink About12737-zTOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~~ 12737 Z Permission is hereby granted to: ~. /~ ,I ~-,...~.?.....~....L...~..u.. ......................................... ...~.~~.....~..:..~.:.....L!..~..~.~ ........... ,o.~~ .......... ~ ................ : .... ~ ..~ ................................... ~....~.~.....~.....-~...~...~-~ ~'~, ,-~ ...................... ~. ................................................. at premises I~ated at .~.~.~...?j.~.~.q~..~.~.~..~..~.~:~?..:~.L...~..~?/s~..~.~:.~.~..~..~%!~.~.~.~.~..~L County Tax Map NO. 1000 Section .... J..L~. ........... Block .... .?..!.i] ......... Lot No......~...!.,~.. ........... pursuant to application dated ...~...~.....~,~.~ .................. , 19~..?-~, and approved by the Building Inspector. Fee $ .. ~..'~... J .............. Building Inspector Rev. 6/30/80 tAW. ./ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined . .~..a334~m~ .~...~.., 19 .t~.~. Approved . .~....~....~...-)..., 195~. Permit No. I .'.'.'.'~."]....~ ..~ Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ............... 19 INSTRUCTIONS a. This application must be completely filled in by Wpewriter or in ink and submitted 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 appli- cation. c. The work covered by tins application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued 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, build~lg-ryode, housi!lg cod_e, and regulations, and to admit authorized inspectors on premises andin building for necessary i~//jx~~- ''' i' ~nature~~ ~ .ff.t~.~~of a~l~a't;~) .... (Mailing address of applicant) Name of owner of premises . . : .lt2.. . .(,~..~-.. (,C ....................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. '~'-~ Plumber's License No ......................... Electrician's License No ....................... Other Trade's License N.o: ....~. .................. 1. Location of land on which proposed work will be done .................................................. ..................... . .nd .... ..... House Num bet Street Hamlet County Tax Map No. 1000 Section ..... //.~...~ ....... Block. ~. t/. .~ ........... Lot...~../...~. ....... Subdivision ..... .~.~ .............................. Filed Map No .... .X .......... Lot..~..... ..... (Nmne) 2. State existing use and occupancy of premises and intended use and occu'pancy of proposed construction: a. Existing use and occupancy .. '(-~. t. ~'. .................................................. b. Intended use and occupancy .. ·/J~'~,4[../ff...6r.~ ...................................... (~ Nature of work (check which New Boilding Addition Alteration Repair . ............. RemOval .............. Demolition .............. Other Work..'g~Vc~ ,~ ~ ..... ..~ (Description) Q~) Estimated Cost ......... ~.C2.~. ...................... Fee J.~.: ""-- i (to be paid on filing this application) 5. If dwellfng, number of dwelling iunits ............... 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 ...................... Q~) Dimensions of entire new construction: Front...~. ~..~'/_~. ..... R?ar ............... Depth . ~.~ ........... Height ~ .3./.. ~!q.°?~.~.( -oqu.m.,b~r-qs'f--S£orieW'.. f... ~/9. ~i~..r7¢.../ ....'~.¥.n4. ¢-~ ......................... 9. Size of lot: Front / .... R -- · ........ : ......... em ...................... Depth ...................... 10. [)ate of Purchase ........... i .................. Name of Former Owner ............................. 1 I. Zone or use district in which pr{mises are situated ...... .~. ............................. 12. Does proposed construction rio{ate any zoning law, ordinance or regulation: .... fao .......................... 13. Will lot be regraded ........ i .................. ; Will ex, cess fill be re~o~ed, from premises:_ Y_es. No ~ Name of Owner of pre~nises ~.'~.t,84... ~.q,~.-g~... Address/~°.0r'.4. .'~..'~..~.~ :l.tc..tJ~hone No.g ~'~.~.~P~.~. ..... Name of Architect .,, ........ ................ Address .... ': ............. Phone No ................ ortf~'f-4r['. {~i ~ .~A,~ ....... Address ~q'~ [~. ~ ~.~,q.q-~. Phone No. ~ ~"~ .~2.~..~,..-~.... lqame of Contract 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 interior or corner lot. ~ ~ STATE OF N.EW-.Y~RIf~/o~ .~ . COUNTY.~g~F~.. "I (Name of ndividual sign]lng contract) above named· being duly sworn, deposes and says that he is the applicant He is the ...................... : ........... ~ ................................................... ~9,~rt~actor)agent, corporate o'fficer, etc.) of said owner or owners, and is duly author[ze-W'ro'~rform'"'c .,- or have performed the said work and to make and file this application; that all statements contained in th-is application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ......... ~ .... day o~ ~. ~-; ....... 19 .~:~. Nora mubli~c ............ ! ~ :.. Coi:~/f~ ,~,4f~,~,,. NO. 52.8125850, Suffolk Coul~qt,~/ x~,,~ ....... v-~t't' ....... / r~rm Expires March $0, 19~--~-~'Y~'