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Home My WebLink About10212-z FOI~M NO. ~ Town o~,s0ui'H°~ TOWN cLERK's OFFIGE $OUTHOLD, N.. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETIOI~ OF THE WORK AUTHORIZED) H°. ~o2~2 z Dete ... ...................................................... , 1 ........ Permission is hereby granted t~/~. ~,,/, k.; ~ ~t:' A -'T/'~ /~/ : .......... · ~'""~ · : ............................................ / ....................................................... /'e'~ ................................ :'"'~ ................. , ...................................... =t premke~ lo~oted =t ................................................................... ~ ................. : ...................................... pursuant to ~pplk~tion d~ted .................................................. , ...~..., ~nd ~pproved by the Building :~ ~uilding In~ector FORM NO. I i TOWN 0l~ g~LJTHalLjD ~ BUILDING;D~'PgRTM!~NT TOWN HALI~ ; SOUTHOLD,, N~¥. 1~97t TEL.~ 765-1803 Disapproved a/c .............. ~ ...................... : (Budding I~spector)~ ; APPLICATION FOR 8U LD:N¢~ERM T ;~ ~ Date INSTRUCTIONS ~ 4 ,, ,i,,,'~ ¢2 / ~_ ~pplication No .................. Other Trade's License No .... i .......... ....... . 1. Locatiofi'0}f land On which proposed work will be done.... ................ ~ ....... ~ .......... ...... House Nfimber ; Stree.t ~ . ~ ~ ~ ::.: H~mlet County Tak Map No. 1000 SectiOn :. c ~ .~. Lot Subdivision ~ ................................... ...... ~ ........ Lot ............... 2. State ex~sting use~and occup~c~ ~f p, re~ses a t~ [ ~ ~ ~ ~b~qse~ Cons~u~tioh: a. Existing use and occupancy .((~.C~ ; ~ g ~ ......... b. Intended use and occup~cy ; ........ ~ . . _L ~ ; .... ~ ........................... ....... (Name and ~itle of corporate officer) cense No. 45)& Plumber'~ License No ....... ! ................... Electriciah's License No ..... !. a. This ,application must be co~mpletely filled in by tyP;writer o~ inii~k and submitted in triplicate to the Building Inspector, with 3 set~ of plans, acct~ate plot plan to scale. Fee iaccord!n~ t~ischedule, i b. Plot plan showing locafion df lot and of buildings on pre)nises, ~el~tionship t6 adjoining premises or public streets ~ or areas and giving a detailed desc~ption of layout of propei'ty m~st be ?awn on t~e diagram which is part of this appli-~. cation ' ; c. The ~ork covered by this apOlication may not be commcnced~be~or~is~uance of Building Permxt. d. Upoq approva! of this appliohfion, the Building Insp¢¢(or :will is~ueiia Building ~ermit tO the applicant. Such permit Shall be kept dn the premises available for inspection throughottt the. x~0.~k, i : ~e. No bhilUing shall be occupieifl or used in Whole or in pa~t for ahy~ p~rpose what~ver until a Certificate of Occupancy ~.~ shall have be~fi granted by the Building Inspector. · i ' APPLICATION jS HEREBY M~DE to the Building 'D~:pa~tment f(~r' ~ issuance}of a Bhilding Permit pursuant to the Building ZChe' Ordinance of the T4wn of Southold, Suffolk County, N}wl~)rk, and ~ther appli?ble Laws, Ordinances or Regulation~ for the ~construction 4f buildings, additions Or alltefafio~i o~ f~0r remove or demohtion, as herein described. The applica~t agrees to comply wi~h al! applicable laws, ordinarlces, Jbgil4!~g code, l~ousing code, and regulations, and to admit authorized inspectors on premises and in buildings for ncce~sa~ iOsp~ctions., ~ ~ ~-- '''' .' ' '~L' .~ ........ ,'": ......... --~/~ . ~ ~/~ : (Sl~.ap~'e'~(~l~l~!~Jant, or name, ifa corporation) ! ' (Mailin~ address of applicant) State whether applicant is owner, ilessee, agent, architect, engineer, g~ne~ral contractor, electrician, plumber or builder. Name of owner of premises ...... : ( ] - (asSort the t. ax ro~l or lhtest, teed) , -~ If apphcant is a corporation, s~gnat~re ~f duly authorized officer. : 3. Nature of work (check which applicable): New Building ... ....... Addition .......... Alteratj. gn .......... Repair ........ ,~,.... Removal .............. Demolition'. ............. Other Work. ~ .~.m...c,..~,~,.. .... (~ ? /' ~' "O 04( ~ , (Description) 4. Estimated Cost .... 3....~.,(fl..?..~. ................... FeeT../,~.:~,..(~. .......................... (to be paid on filing this application) 5. If dwelling, number. 0f dwelling:units ............... Number of dwelling units on each floor ................ If garage, number of cars .... i ................................................................... 6. ] f busi~aess, commercial or mixe'd occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... lteight ............... 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 ............... Number of Stories ........................................................ 9. Size of lot: Front .......... ; ........... Rear ...................... Depth ...................... 10. Date of Purchase .......... ; .................. Name of Former Owner ............................. 11. Zone Or use &strict m which pr, em~ses are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ....... .,~ ......ra ............. Will e~'d~ess fill be¢~emoved from premises: .,._.Yes _,,N,o 14. Name of Owner of premises . ~.Ol. ~ .{O.~6[~F~gl.. Addres~t~t')~(,/~/.~. ....... Phone No. ~..°'. Name of Architect ........................... Address ..... 1 ............. Phone No ................ Name of Contractor ........ ~ .................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly ali 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. STAT or m .w .ITp . ... r l .~.0 [. I0. --.- .,1~ -~-'[~' ~C¢'.~ .................. being duly (Name of individual signing contract) above named. sworn, deposes and says that he is the applicant ~.' He is the ....... , .................................................................... (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 in the manher set forth in the application filed therewith. Sworn to before me this .. ~f' O..,.,.a ,. ~..o,~ Co~.,~ iSignature of a~hcant) TOWN ~-ALL SOUTHOLD, N. Y. October 10, 11980 Kev&n Gratta~ Box 373 ~ Sunny Side Ho!ad Southold, Ne~ York Dear Sir: This is to notify you that Building e to ±~ xplre on November 4~ If more time is required to Complete[it~ Certificate of Occupancy, you-may apD1~ six (6) month~extension. If the work is not completed~a~d~t~$ Ce not issued afSer the six (6~ than requiredito apply for a bui~d~ Very truly yours GEORGE. H. FIS~ER S~. Bumlding ~nspector 'GHF/raw TEL. 765-1802 mlt No.I ..... 10212Z ie job ~d obtain a i, by letter, fo~ a ~fica~e.of Occupancy Sion p~r~o~, you are' hg permit.