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Home My WebLink About10390-z FOIt~I NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N*. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) 10390 Z Date ' ' ~'-'-, 19..Z Permission is hereby granted to: , ,) / , /./ . _~.: ............ r / p , .................................. ~ ..... /~ ..................... ~ .................................... ,=.. ..................... ......... ..... Building Inspector. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 j~ TEL.: 765-1803 Examined .~/~:-_.. ,d ..... , 19/. ./ Approve~7~.'.~.. ~' .... , 19~TPermit No..//~.t~.. ~o~sapproveQ a/c .......... 7 .......................... ? / /7// .................. ~: ~. ~..~i'~.~-~'/ ......../~"/'{ ~ ...,~.~ .,~. ~~/_~j~,._~. (Builditfg Inspector) APPLICATION FOR BUILDING PERMIT Application No../.(~ .~.' 7('~ ........ Date ..... .A.u.9.u.s.t~ .2..8..., 19..7.9 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, accttrate 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 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 issnance 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 herren 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. (Signature of applicant, or name, if a corporation) Route 27 A Southold, N.Y. 11971 (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, enl~neer, general contractor, electrician, plumber or builder. owner Name of owner of premises .... .W.a.r.r.e.n. )}: .H.u..f.e~..J.r....&..E.'i..1.e.n..H.u.~.q .(.w..f) ............................. (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 L~censeNo ......................... Electrician's License No ..................... Other Trade's License No ...................... 1. Locationoflandon..whichprg_posedwo.rkwillbedone..~.°.r.~.h.w.?.s?..q°.r.n.e.r. .1. ??. .-. .~.°.u.t. % ~ 7. ). .5 .......... z~.~. Kenney's Road Southold, NY 11971 House Number Street Hamlet County Tax Map No. 1000 Section ]O..o.O.:.,~.O[. 7.~.'.~..3Block .. ]..~0. ~.g.J ...... Lot .................. Subdivision ................ (~q'a~) ...... " ........ Filed Map No ............... Lot ............... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... /~la~h£o¢. Chpp. ......... , ................................... , ..... b. Intended use and occlpancy ..... s.a.m.e.., r.~.X?..W~.~..~.~.~.~ .. ................... 3. Natureofwork(checkwhichapplicable): New Building .......... Addition .......... Alteration 2 ......... · , . . XX Erection Repmr .............. Remoyal .............. Demohtlon .............. Other Work ............... of fence ~ / / (Description) 4 Esti d $ 5OO.L~O6 · mate Cost .................................. ... Fee . ............................... , ... .. (to be paid on filing this application) 5. If dwelling, number of dwelling Units ............... Number o f dwelling units on each floor ................ If garage number of cars ' 6. If business, commercial or mixed occupancy, spec/fy nature and extent of each type of use ..................... 7. Dimensions of existing structure~, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. ' Number of Stories Depth Height 8. D~mensmns of ennre new construction Front ................ Rear Depth ............... Height ............... Number of Stones ............................................. , ........... 9. Size of lot: Front ........... , ........... Rear ............ ' ........... Depth ...................... 10. Date of Purchase ............................. Name of Former Owner ............................. 11 Zo dist' t' whichp ' ' 'tuat d · ne or use nc in remlses are si e ............. . ....................................... ~ro ' ' l~t gui 12. Does p posed construction vm e any zoning law, ordinance or re ation: ................................ 13. Will lot be regraded ......... i ................... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .................... Address ................... Phone No ................ Name of Architect .......... . ................. Address ................... Phone No ................ Name of Contractor ... Adamac n .Lansdcmgin9.. Address . .Mat~:i~:uck,. A'Y... Phone No...890.-~15~M ..... PLOT DIAGRAM Locate clearly and distinctly all ibuildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block mmber or description according to deed, and show street names and indicate whether interior or corner lot. · "-./o ~ y STATL OF NEW,, ORK, S" ",.. i ...... ~ ..... .(~...~ .................. being duly sworn, deposes and says that he (Name of individual sign!ng contract) above named.. He is the .... ~.... ........ ----~..77. ............................................................... (Contractor, 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 application; that all statements contained in this application are true to the best of his knowledge~and belief; and that the work will be performed ~n the manner set forth in the application filed therewith. Sworn to before me this Notary Public, . .... . .3~..~..: .......... County//~ i ........... , i S IC St=l® o! Ne'~ ~r~l; [' ........ . . o?,r No. (S, nature of apphcant) is the applicant