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Home My WebLink About10330-z FO1/~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH*OLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL cOMPLETION OF THE WORK AUTHORIZED) N? 10330 Z Permission is hereby granted to: ........ ..~....~...~..,:'Z.e.c~..-....~:..~..: ....................... .................. to ..... .~.a.~.~Zt../z~.~.~. ....... .c...6/. ./..o...~ ~,~... .~,. ~.z~.Zc.... z~..:.~.....~....f~ ~ ............. , ........................... pursuont to application dated ......... ~..~.~..~......./..2 ................. , 19...7...~., and approved by the Building Inspector. FOII, M NO. 1 /~£~io~o'/,. TOWN OF SOUTHOLD BUILDING DEPARTMENT O0,T;Q~.,:N,. L'~* CLERK'S OFFICE O0 ~UTHOLD, N. Y. E . -~ ~ Application No..~.~/..~ ............... ~proved ~[f~ ~/ ,9Z2 Permit No/~0 ~ isapprov~ a/c ............................... ~ ........................................................ ............................................... APPLiCaTION FOR BUILDING PERMIT INSTRUCTIONS a. Thls application must be completely filled in by typewriter or: in ink and submitted in trplicate to the Building I~ _~p.,~o~,;~jth:,~. .- ~- 3 set$~Lf.. Bl~/3s~r~r,q~)p. et P an to scale Fee accordin~l to, chedu, , b Plot p}an show,ng Iocat,on of lot and of build,ngs on premises, relatlo[~t~'l~ fo~;~j~ining prem,ses or public streets or 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 Budding 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 o 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 lows, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in, buildings for necessary inspections. .... wZ.n.. J). o:nk.. ,[ ez~ c.e....O.o ................................... (Signature of applicant, or name, if a corporation) .R...q.q.~..e. ~7~. Mattituck, ~ew Zork 11952 (Address of applicant) State whether opphcont is owner, lessee, agent, architect, engineer, general contractor, electriman, plumber or builder. ............................... ~.o~.~.~'a,q ~ az:. .......................................................................................................................................... Name of owner of premises .............................................................................................................. If applicant ~s o corporate, signature of duly authorized officer. ............... S.,....~..o ~.~.i~ 0~.~ ........................................... (Nome and title of corporate officer) Builder's License No ..................................................... Plumber's License No. ~ ................................................ - c 'Z ?- 07 Electrician's License No ............................................. Other Trade's License No ............................................... ~ "- Location of land on which proposed work will be done. Map No .....................................,a~o~e?.j....,.~' .......... Street and Number 1.~.0. ,A-~tervzew Drzve~ ~ou~hold,. New York 11971 Municipality State existing use and occupancy of premises and intended use and occul~.~6~FB[6~ed construction: a Exisiting use and occupancy o~e-£a~ily dwelling b Intended use and occupancy .o.n.~-f~il~ dwellin~ 3. Nature of work (check which apphcable): New Building.. ................. Addition .................. Alteration ................ Repair .................. Removal; .................. DemoHtior. .................... Other Work ..... £.~tl.e,$ tzg ............................. (Description) 4. Estimated Cost ...... t~..1..¢.5.~.,.0~). .................................. Fee ..;[~.¢5.~D0 ......................................................................... ' (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 ............................................................................................................................................ 6. If bbsiness, commercial or mixed occupancy, specify nature end extent of each type of use ........................... 7. Dimensions of existing structuies, 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 coqstruction: Front .................................... Rear ............................ Depth ........................ Height .................... Number] of Stories .................................................................................................................... 100 ! 100 ' 200 g. Size of lot: Front ................. ~ ...................................... Rear .......................................... Depth ................................ ]0, Date of Purchase ........................................................ Nome of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12 Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regroded .............. ~ ............. Will excess fill be removed from premises: ( ) Yes ( ) No Nome of Architect .............................................................. Address ................................ Pkon~ No ....................... Name of Contractor ........................................................... Address ................................ Phone No PLOT DIAGRA~ Locate dearly and distinctly a[I buildings, whether existing or proposed, and indicate oil set-back dimensions frore and show street names and indicate property lines. Give street and block number or description according to deed, whether interior or corner lot STATE OF NEWo¥.Q~,~. '[ S S COUNTY OF .,.........,o~.z..u...~..~ ............ )' · ~. ~e rico~e .... ' .................. being duly sworn, deposes and says that he is the applicam (Name of individual signing contract) above named. ~e is the ................................................................................................................................................................................ (Contractor, agent,r corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and fi. lo th s app ication; that all statements conteined in this app!ic~tion are true to the best of his knowledge and belief; and tha~ the work will be performed in'the manner set fo~h in the appl cat on fi ed therewith. to ~before me this , ~ ' Sworn ..... ............ 7.. ~y ~ ~ _ ~ (Signat~r~ o* applicant) NO 5~.8J25850, $uffoJ~ ~uRty : i J Term Expg. March ~ 19~