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Home My WebLink About14364-z I~ORM~ NO. fJ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NO 14364 Z Permission is hereby granted to'~'~2 ........ ~...~..7.....~......~...~...~...: .......... ....... Z~/~c~....~.~.~..~.../..~.~.~ cou,,, Tox Map ~o. lO00 Sect,o, .,0:¢.~... ......... B,o~k ..0.~ ......... Lat No....O..~..-Z... ..... pursuant to application dated .....~..C~..~.......~.. ............................. , 1~...~.., and approved by the Building Inspector. Building Inspector Rev. 6/30/80 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 \ TEL.: 765-1803 Examined O.c'.~..../.,~.-. .... , 19Y. Approved Disapproved a]c ..................................... · (Building Inspector) APPLICATION FOR BUILDING PERMIT OCT II 1985 ___%OWn.___OF ,$o,u'r. om, Received ........... ,19.. · · ' Date ............. ./.o../? 19 .~.4" INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ~ets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildh~gs 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 issued 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 skall 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 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 building for necessary inspecti~tj:~/n /.k~,-,~. t.,~ ~,~ (Signature of applicant, or name, if a corporation) 341 ~, Sq~ &TFLX, ~t~t ~o~.~- (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ........................................................... (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..~.l../~..~.l..~..~..M. ??.,!~. ~.'.../;t44t. lO Dt~O ~/4-q -lll4- Plumber's License No.-~..l~...~.g..~.l..' ...... Electrician's License No. g..~. ~/t.~../:ff..g~..T~..~.. ....... Location of land on which proposed work will be done .................................................. House Number Street Hamlet County Tax Map No. I000 Section ~r$ Block ~ Lot ~7 Subdivision F:~Z~.~PCIt~IT~I[/I~N ~ Filed Map No. ~r~ Lot (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy b. Intended use and occupancy d//~ F--'/~ll~ 3. Nature of work (check which applicable): New Building ..... '. .... Addition i ......... Alte on ........... Repair .... Removal .............. Demolition ......... i .... Other Work[..[a-~...~...~.. L (Descripti;~)./ 4. Esmated Cost ............................ Fee ............................. " (to l~e paid on filing this application) 5. If dwelling, number of dwelling units I (ot45) . i . ............... Number of dwellxng units on each floor ................ If garage, number of cars ........... ................... ......... . , .............................. 6. If business, commercial or mixed occupancy, specify nature and extent of each {ype of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear ..... ......... Depth ............... Height ............... Number of Stories .......................... J .............................. Dimensions of same structure with alterations or additions: Front .......... ~ ....... Rear ............ , Depth Height Number Of Stories .... ~fi."q" Rear .2'.~'O." Depth 4/.2..'-.O." D~mens~ons of enhre new construction: Front ................. ... Size of lot: Front ~P.:.'.q". ............ Rear Deptt~ ' Date of Purchase .. J.~.?.?...~T~..~.. ............. Name of Former Ownerl . .E .e-L~..~. .by ~?.~.'~. Zone or use disfavor in which premises arc situated../~..~17..~.../~,. ........... I .............................. Does proposed construction violate any zoning law, ordinance or regulation: .~.i~.~..~ .......................... Will lot be regraded . .¥~.$. ....................... Will excess fill be removed from premises:. Yes ~/No Name of Owner of nremises .~'E).~'..g'g4~v°~ A~am~ 3n-'t~.g'~r~N~/tdo~l~ Ph,,,~ xr,,/rJ Nme of~ch~tect ........................... Address ...... ... Phone NoL 1 ........ Nme of Contractor .V~.~'.~'.~'gY~gg.. Addre~ ~'~~.~. Phone No.~ ~.-.1~ PLOT DIAG~ Locate clearly ~d dis~cfly fll bufld~gs, whether existing or proposed, ~d~indicate fll set-back d~ensions from prope~y ~nes. Give street and block numbar or description accord~g to deed, ~d show street nines and indicate whether interior or corner lot. 9. 10. 11. 12. 13. 14. STATE OF NEW YORK, S.S COUNTY OF ................. , ........ ~ Id'l~'~/~vt being duly sworn, deposes and says that he is the applicant '. (Name of individual signing contract) above named. He is the ....................................................... O o. xM .~?., , ......................... (Contractor, agent, corporate officer, e~c.) of said owner or owners, and is duly authorized to perform or have performed th~ 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 manner set forth in the application filed therewith. Sworn to before me th~(~ ............. ,,/~. t/ ...... day of ....... ,19. / KATHERINE TAYLOR // Pubti'c State of New Yo~( . . I;Iotary No. 03 4~0462t I X .~.t .'...'.'..-T..'::: L. Qualified In arotlx OOUllty '~' I~ C'mhllflssion E×pl~'oS IV[are~ 30, 19gL./ (Signature of applicant)