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Home My WebLink About10749-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, iq. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°. 10749 Z Permission is hereby granted to: -/ ....... . ..~.z~....~.~.'...,c~.......z~-~.~.~. ~.~ ..~.... ..... ~..:..~... ...... ~ ............ /. ........... to ..... ~o...,~..~..,:~.~.z:.......~,~/..,. 27 .z;.~.: .,_,... ~.~.~T. ............................................... ......................................................... Z-/~.',...~ ..... ~.~-,.~..~...~.~z~. ........................... at premises located ......... 7' ..................................... :.....~,) ................. .~.~ _~ 7. .................... Z ............................................................ ...~.........Z.~.....-~.....~...~.. ...... ........ pursuant ,o application dated .... k~.~.~........~ .......................19 .~,,J., and approved by the Building Inspector. ~ee *../.~. ............ ~uilding Inspector FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Approved~/.~..~.'-. .... 19& Permit No../.~..~..~.~. '~- Disapproved a/c .... : :.; :..: i-. ........ '/7 ........... / APPLICATION FOR BUILDING PERMIT Application No./.~.7'."/~.~. ....... Date ~/~me-~ ~ 19~..C> 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, 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 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 buildmgs, additions or alterations, or for removal or demolition, as herein described· The applicant agrees to comply with all applicable laws, ordinm~ces, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessaw inspections. · i. }'.b.,.,.~....~. r.v,....s?. ~.~?. ~...C.o.: ............ (Signature of applicant, or name, if a corporation) · .~. ~....B~.¢... ~ t... ~ a .-r:r..I.x.~,.~.....~: .Y: ..... (Ma~ing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......... e~..~.4. ~.~.~.,r ........................................................................ Name of owner of premises . .~..fl,.4r..~..C.* .... h-~.~.~ .g....~..~...t].,.~.,.~.. ..................................... (as on tlie 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 LicenseNo ......................... Electrician's License No ..................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done ..................... .-~9~c,4t.qqS.Q .~-. ~ ............ ~. ~.z~ ..... .a/~,.~...~.,~ ~+... ~.d.. ..... ~.,~.~ .~..?..+...... ~..~.. Y.o.~. ~, ............ ~ House Number Street Hamlet , County Tax Map ~No. 10~/0 S~n ..... Z.~ff't"d ......... Block..../..~..' ......... Lot . . . .c?.Z..,/¢~, .......... ir Subdivision .~/2~.~-~ .¢¢A-<....~ .... . .'~.. 1¢?~///.,. .......... Filed Map No. ?..'~..~. ........ Lot.. '~....~. ......... , (Name) Y 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ... O.~..e,<~.. ~g~.ox.~ 1. .... dl~.~.l..~ .................................. ...... ..... _/ - . b. Intended use and occupancy .. ~*.-. Ot,~.t3~.¢v~ t ¢~] k~.,.. ~..¢.~.~..~: 3. Nature of work (check whicD applicable): New Building .......... Addition .......... Alteratit~tl~ .......... Repair ......... Removal .............. Demolition .............. Other Work :~f~.~.L~. ~... (Description) 'A6'700 4. F, stimated Cost ....... ~.. ~.q.O.,.O..O. .................... Fee .................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ If garage, number of cars ..... i ................................................................... 6. I[' business, commercial or mixe~ 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 .................... i. · Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories 9. Size of lot: Front .... [ .~.O. ~..: ........... Rear ....... ].. 10. Date of Purchase .......... J .................. Name of Former Owner ............................. 11. Zone or use district in which premises are situated ........ ~ ............. 12~ Does proposed ~onstruction vioiate any zoning law, ordinance or regulation: ..................... 13. Will lot be re~raded ..... J ................... Will excess fill he removed from premises: . Yes No 14. Name of Owner of premises . ~¥¢-~¢, .... Address : ~t~l: . one No.F~..~t ..... Name of Architect ........................... Address ................... Phone No ................ Name of Contractor .......................... Address ................... Phone No ................ Locate .clearly and distinctly all property lines. Give street and block interior or corner lot. PLOT DIAGRAM buildings, whether existing or proposed, and, indicate all set-back dimensions from number or description according to deed, and show street names and indicate whether y i STATE OF NEWZ't'OAX~, . COUNTY ..... : s.s ......... ..~.*..~..4~"e' .... e,~.O .e~ ...................... being duly sworn, deposes and says that he is the applicant ' (Name of individual sigping contract) above named. He is the .... .~.~ .¢~N~r~.~l .f~...i .................................................................... (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 apphcatlon; that all statements contmned m th~s apphcation are true to the best of his knowledge and belief; and that the work will be performed in the man~er set forth in the application filed therewith. ' Sworn to before me this ~ ,¢ , ' ,~.~0..._ . . .~...~.. ,19..~.' ~ ' ...: .... . .....~'. ~'...._...day 0f.. : ........ ~ NotaryPublic,~.'~.~..~. ~ ...... ~ ~ ///~ ~_ Commission Expires March 30, 19&,4~ ~