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Home My WebLink About10216-z FOEM NO. ~ TOWN OF,;SOu;,~OLp BUILDING DEPA~RTMEN~ TOWN C~.~RK'~ O~FICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISl~S UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 10216 Z Dote' Permission is hereby granted to: ....... ..X..~.z..~.;......X...~.~. ................... .... ~z ........ ~..;~...~L.:. ................ .~z~~....~..:~..:....:.....,__ ~ _~ ........... , , ,~..~.~z~z...~....~,.~....~...~.....~....~.Z~.~ ........ ......................................................................... : ........................... ;--...~ ............................................ at premis,s located at ....... ..... F...:.,~.~.,(.~.&~...~.. ...... ~.~..~.~ ....... ~.~,~..~.....~.~..~4 ............ .~.z.....~z .................. Building Inspector. Fee ,..Z~...'.<..~ .... Disapproved a/c ~ Application No.../.~.'.C~.~./.~. ....... PERMIT APPLICATION FOR BU LD : ' : ' ii Date . < ; · , INSTRUCTIONS , a TMs gpplication must be ~ompletely filled in by: 'typewriter p~ ~ Inspeetor~ ~ith 3 sets of plans, accurate plot plan to scMe. F{e acco~d~g~ b. Pi& ~lan showing locafion~ of lot and of buiid~g~ bff p~e~i~,, r~ or areas, bna ~ving a det~led d~scfiption of layout of ~roper~'mh~ b~ cation. } c Th~Work covered by this a~plication may not be c°m~ehced b~fc d. UpOh appro9al of ~is app~cation, the Budding I~y?tffr ~1 ~s~ sh~l be'k~Pt~ on the premises arable for inspection thro~g~offt th~ ' e. No b~lding ;~all be occupied or used ~n whole or In pa~ f~r:a~y ~1 have;~e~n graflted by the Building Inspector. , , i ~PLi~AT1ON IS HEREBY ~E to ~e Building ~e~ar~m~t~o~e issu~e of a ~Building Pe~it pursuant to the Bufldigg Z~ae Ordinance of ~e Tow~ of Southold~ Su~(olk~CdU~ty,~e~ york, ~gther appl~able Lg~.s, Ordinances or Regul~fio*$, for the c0nstrucfion{of Buildings, additions ~r.~t~rati$~s. ~r :for rem$~al or aemolition, as he,in described. The appli~t agreSs to comply ~ith all applicable laws, 0rdinanc~/~Ui~fig code~ ~h0using code, and regulations, ~d to a~mit autfi~ed ih~ectors on pr4mises and in buildings {or geces~a~ an~e~tions. : . .... .......... a~nk and ~ub ~ted in triplicate to the Building o.'~cheduf~ ' [~tionship ~to adjoining premises or public streets drawn off ~he diagram which is part of this appli- 'e!issuanc~ !of Building Permit. e!i Building Pem~'it to the applicant. Such permit urpose wh~ttever Until a Certificate of Occupancy 1. Location of land on which propSsedwork will be done. , .: ........ ~ · ,~,;, .....~i ..... ' ·: ..................... House Number [ Street H~mlet ' Lot. Subdivis~6~/ ..... ~. 2. State exiSting use and ~ ' occupancy,.of premises a. Existfiig Use and occupancy ...'.. b. Intended'use and occupancy . .c7..~.'.~....~.~0~3.~,~,..:.. construction: (Name and title of corpdrate officer) Bttilde~'s'Lic: en~e No ~:. Plumber's License No. Electri6ian's License No./'' Other Trade's License No (S~gti~ture of applicant, or name, if a corporation) ...,..;,~ .. . .;~ '''' , . . ,, : ~ml~g addres~ of apphcant) State whe~aer applicant is ownerj, lessee, agent, ~chitect ~ e~eei, f~'ea~' ~1 contractor,, ,, electrician, plumber or builder. . ...... . .................................... Nme of ow~Or of p~emises ........ ~.~.~ · ,~. ~ ~ .¢~.~ ..... · ,~ ............................ ~ (ason the ~ r~li;or, latest deed) If applicant ~s~a ' ' ~ ' co~orat~on, s~gnatCre of duly authorized 6ffider.. '~ 3. Nature of work (check which applicable): New Building ...... Addition .......... ' Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work .............. ........ .. 4. Estimated Cost ,. ~ ~.) ~ ...................... Fee ....................... ,(to be pa~d on flhng thru apphcatmn) 5. If dwelling, number of dwelling units ..... C,. ~ ~.Q), Number of dwelhng units on each floor... O.~..~ .(3 .)... If garage, number of cars ....... ~., ,~..'99.q . . .[..&-.) ....... · ,~,- If business, commercial or mixed accupancy, specify nature and extent of each type of use .................... 'qT'. Dm~enm0ns of ex~stmg structures, ff any: Front ............... Rear .............. Depth .............. Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. De th .. .................... 'l Height ...................... Number o,f ~torie,~ .............. .....~ . · · (~ Dimensions of entire new constru4tion: Front ..... ~ .~ .'..g .~. l~e~,r . i...'7'] ~ :. O. ::. Depth ...~P..'..O. :1.... "-' Height Number of Stories ...... 0 tg.~. t ~.) .... z ............. · ' ............. ~,0 ~'~-~-/- /0,~'~' ~T" 'o/ F~-vt2 ~,l& 9. S~zeoflot:Front .... ~( ...... ~ ........ Rear...~ .................. Depth ~. .................. 10. Date of Purchase . . . Pl~ ~.~O~! .i~,~ ~...~.G .qr. .... Name of Former Owner . . \~ ~.6.~.~'A..e~., . .~-.~.~ ]~a... 11. Zone or use district in which premises are situated .... I¢, ~--~ l .'~ .~-l'¢.'t-.~.ex.l~. . .[. ~ F~.~. ~k ~eg,..~.4.~.e.~.) 12. Does proposed construction viola(e any zoning law, ordinance or regulation: ........ t,3.q .................... 13. Will lot be regraded ........ I,¢2.O, ................ Will excess fill be removed from premises: Yes 14. Name o~ Owner of premises . .~,p??~.. ~'x~..~ } .~,q,~i~ddress .h~. · ~.w. ¢..~..C~tC~-~. Phone No..~.'/.D. 7 ).~ .... Name of Architect ........... ~ ................ Address ................... Phone No ................ Name of Contractor ~. :'~. ~. 0 ~ ..... Address ~o[. ~V~v. ~2~,. ~[Phoge ~o- ~-O3. x .~ ~ ~ t .... PLOT DIAG~ Locate cle~ly ~d distinctly ~1 bufld~gs, whe~er existing or proposed, ~d~ indicate all set-back d~ensions from prope~y lines. Give street md bloc~ n~mber or description according to deed, ~d show street n~es and indicate whether intefiororcornerlot. . [ ....... ~ ~- 2~ ~t~ ...; _ .- STATE OF NEW YORK, COUNTY OF . . ~..¢. ~.ff6.~ S.S ......... ~,e ~ ~_P~T... 3*3... ~t~ ~.l~: ............. being duly sworn, deposes and says that he is the applicant (Name of individual sig¢ing contract) above named. Heisthe .. ~.~.~'~ ~ ~.~ ~...~,. ~B~ ................................... : (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is dqly authorized to perform or have perfomed the said work ~d to m~e and file this application; that ~1 statements contained h this application ~e true to the best of his knowledge and belief; and that the work will be perfo~ed in the m~er set forth in the application filed ~erewith. Sworn to before me this ........ ~.3. g~.' ....... day or..~.e~.[ ~ ............ 19~h NOTARY PUBLIC, Stato of N~w York ...... ~. . . ~ .......... No. 52.4602497 (Si~B~r~ of applic~t) QuaJi~ied in Suffolk CounJ~ Oommb~J~ Expires March 30, t9~