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Home My WebLink About10154-z FOR~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 1015~ z Date ........................................................ , ........ Permission is hereby gronted to: .......... :!':'"i: ........ ;:i ......... '::~'"":"; ......... :' at premises located at ............................................................................................................................ .:?,'/;'19:2. and approved by the pursuant to application dated .................................. ~.!..~....?. ........ , Building Inspector, Fee $ ......!...~. ............. Building Inspector FORM NO. 1 TOWN OF SOUTHOLD BUILDtNG DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Approved i . 19 .~.~Permit No... (?..(?.' .£(~'~ Disapproved a/c ........ '~' ' '~' -~-'~:4,[ j~' ' ' (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ... 3/.~Q ..... Application No. /~) /~' / ..... ]97.9. INSTRUCTIONS a. This application must be completely filled ~n by typewriter or in ink and submitted in triplicate 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 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 Bui/ding 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 w~th all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. r ......................... (Signature of applicant, or name, if a corporatmn) 2..29..E., . .6.7.~.I~. ~.t...,. lXl...y, C....1002.1 ........... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. Owner ........................ Name of owner of premises .... 5..u.i.5.~.n.. ?....D..~y~.e.s.. ,/../~.n..n.c..D.a.V.:[.o.s. ................................. (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 Lmense No ........ .~.?..~. ~ ~.~, ...... Plumber s License No ........................ Electrician's License No ...................... Other Trade's License No ...................... Location of land on which proposed work will be done ...... l~.ob ±ns.on. Rd...,. ~.eenp~ml:,. N...¥ .......... ..: ...... ........................................... ....................... House Number Street County Tax Map No. 1000 Section .. 03/t ............ Blocl~ ....... (fLve) .... Lot .... Z(2 ........... Subdivision ..................................... Filed Map Np ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ......... .4~./.~..~ ....... .~.~../~./..J-:.~....~...~..~f; .6../..~.~ .~. ................ b. Intended use and occupancy ......... :~.f.~../~.. 5 .......~.( .~./.-(,. ...... .Z...~).~..~. ~; ..... .~..~..N{.C;..&~.. , , 3. Natur& of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Rembval .............. Deroolition .............. Other Woske xp~ncl. £.encb.d ~,,~ 0 ,- ~ zn a~l%%ript~on)- 4. Estimated Cost... fl~"(~. · .,~.,~.~ ................ Fee.../.~. ................................ (to be paid on filing this application) 5. If dwelling, number of dwellingjunits ....1. .......... Number of dwelling units on each floor ................ If garage number of cars , 1. 6. If business, commercial or mixeld 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 sfructure with alterations or additions: Front ................. Rear .................. Depth ................... '... Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size of lot: Front ...... lO. Gl ............ Rear ... 2LdO ............... Depth .12~ .................. 10. Date of Purchase ...1./3D./.7~ .................. Name of Former Owner ~Barbaxa. D.amman ............ 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction wolate any zonmg law, ordinance or regulation: ...n.q ........................... 13. Will lot be regraded . . i ........... Will excess fill be removed from premises: Yes No 14. Name of Owner of premisesJ, ulie.n .Da.v.~.e~ ..... Address . 2.20 · E....67tl~ .st,Phone No. 2t2..86t..7.~2 Name of Architect ........................... Address ./~..Y.. 3,0022 ...... Phone No ................ Name of Contractor .......................... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly al! buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and blocl~ number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF N~'~O~I~,. OD~ , . .~.. ~ ~ ......... being duly sworn, deposes ~d says that he is the applicant (Nam ~ in~l ~ing contract) above named. (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly author~ed to perform or have perfomed the said work an&to m~e ~d file this application that all statements co~t~ned ~ this application are true to the best of his knowledge and belief; and that the work w~l be perfo~ed in the m~ner set fort~ ~ the application filed therewith. /D . .day ~ 19 c ......... r~ **o~ ~,. ,e~ ,o, ~ (Signature of applicant)