The URL can be used to link to this page

Home My WebLink About10202-z FORi~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 10202 Z Permission is hereby granted to:~ ........ ,z~z.c~.~*.~.~....~...c~.~. ~. ~..~.z. 2 .... · ..~.7.:...~.o...../.,z..:.....Z~.~:~,.~..../~.. .......... · ~,r4~4~,..Z;/:~.. ~. ~.. ~..../~......~... ............. ~o ....~.(..'.Z~.~.Z..~.C~... ........ .~........-..r, Z2 ........ 7'r../ZC-r.~.z...~.~r.....~..../~..,:g.(...~. ...~,(.~...~ at premises located at ...... ,~.~.~..[.~/....~,~z .?./...~,.f~.... ~..~.~....~.,.....=.../.~:..~:~.....z~.c.~.~.. .............. ./.c,:7........~....~ .................. pursuant to application dated .......... ,,~'~.-r....~.. ............................. , 10~7...~.., and approved by the Building Inspector. " " /~'YJ~'~'Building' Inspector ~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined., ...... ,197.? Approved., ........ I;7. Permit Disapproved ~/c ........................ ~ . ,. IILDING PERMIT 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, accurate plot plan to scale. Fee according to'schedule. b. Plot plan showing location of lot and of buildings on premises, relahonship 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 o£ 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 Bmlding 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, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspecti~ (Signature of apFlicant, or name, if a corporation) ~ ~ ....6.7.--.~9. ~orh B~Vie¥,/ .................... · (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ... 0~),3?1-°~.c~5P, ~o,.3.-92a.e. · ?,9~.D$.dfq~ ........................................ (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 No ...................... Leeward _(~cre ' s (~,yVS__~vT) 1. Location of land on which proposed work will be done. /~..~.'~...X~..~.~..qt...~. ~.~.0. {',O,..~,J ...... .6/ .............................. . ' .... House-Number Street Hamlet County Tax Map No. 1000 Section ....~.7..~. ......... Block ...O...7. .......... Lot....~. '.~. .......... Subdivision . · .'~.~?.'.'~..~.~.'.~- ............ Filed Map No. d'b-79~ Lot (Nmne) 2. State existing use and occupancy of premises and ~ntended use and occupancy of proposed construction: a. Existing use and occupancy 39. vLv.~ ~ce. J~ov_~ .................................................... b. Intended use and occupancy .~..~...~.~ ~'....C~O~,[]I~ ....~.~...(~9~;.[~...~?~.~..~. ) .... / 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. RemOval .............. Demolition ........... Other Work..-0~e.r).ee ....... (Description) 4. Estimated Cost ... ~W.a .It~:adz'. eB..[l~o3_.Zax'~ ............ Fee . .I5...Q9~. jO.q~...~.a.~.s. ................... (to be paid on filing this application) 5. I( dwelling, number of dwellinglunits ............... Number of dwelling units on each floor ................ If garage, number of cars .... i ................................................................... 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 ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... NuCber of Stories ........................................................ 9. Size of lot: Front ....................... Rear ...................... Depth ...................... 10. Date of Purchase .......... '. .................. Name of Former Owner ............................. 1 I. Zone or use district in which pfemises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ........ I .................... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .. i .................. Address ................... Phone No ................ Name of Architect ........................... Address ................... Phone No ................ Name'of Contractor ........ i .................. 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 block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE }F NEWYORK, S.S .... ,~..~'~/~-d....~..:~-'~f.<~ ...... being duly sworn, deposes and says that he is the applicant ' (Name of individual sig~ing contract) above named. (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is drily authorized to perform or have perfomed the said work and to m~e and file this application; that fll statements contained ~ this application are true to the best of his ~owledge and belief; and that the work will be perfomed in ~e m~ner set forth ~ the application filed therewith. Swomtobefo~~ ~ ~,,~ .......... ~ ....... day ;f... ~.~ ...... 19 .~ ~ (Signature of applicmt)