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Home My WebLink About13962-zTO~N O~ $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 13962 Z Permission is hereby granted to: . ,~ ~ .~.~~.....~.~......~.,A~:~::~ ....... .~.~e. ~~.~.~.,,.~ ........ .~.~.L...~.,..~.,...I..!..~..~./. ...... ~ to ..~....~......~l..-:..o......~.....K,,~...~.,....~ ................... ,t premises located ot ...t...O....~....~...O.. ...... ~.gd~...~....~...~...~..~.....~.~J..~.:....J~.~ .... .............................. County Tax Map No. I000 Section ...... J....~...~. ........ Block ...~..~ .......... Lot No ..... .~... ............. pursuant to application dated ........... .....~......~...L..~. ................. , 19.~...~..~., and approved by the Building Inspector. Fee $ ........................ Building Inspector Rev. 6/30/80 CUR 15' ENCESYSTEMS ~ou~hold, NY ~ 197! BOPOSAL SUBMITTED TO of Pages ,% ~' ~t'¢lltl[t~' hereby to furnish rrlater~al and tabo~' complele m accordance with above spe¢ff~cahons, for the sum of' Payment lo be made as follows' ..................... dollars ($ ..................... Note: Th*s proposal may be and conditions are satisfactory and are hereby accepted, Yoll are author*zed to do the work as specibed, Payment wdl be made as outhned above 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1803 ;xamined )isapproved a/c (Building Inspector) APPLICATION FOR BUILDING PERMIT L_ TOWN OF SOUTHOLD Received ........... ,19... Date . .~.--~.//. ~ .......... 19~..~'~ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submiffed to the Building Inspector, with 3 ts 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 areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appti- tion. 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 all 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 all 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 filding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or ~gulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. te applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to mit authorized inspectors on premises and in building for necessary inspections. .......... (Signature'-df applicant, or nh/he, if a corporation) ~. ~. ~. ~. ~rd. b,.~ .Si~r~,o! d..~./.,.t.~ v.I.. (Mailing address of applicant) :ate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. [me of owner of premises ...q.Y).~.w.~'.,;r'..UCCC....~. I~.~' b.l.;~-,,. ~neJ. kl*;aT~.O.~. (as o~ the tax~l or late~L~d) applicant is a corporation, signature of duly authorized officer. ............................................ (Name and title of co, orate officer) ~ ~ ~ ~1~ < ~ ~ ~ Plumber s Ltcense No ......................... ~ZOu~c~ Electrician' ' 's L~cense' No ....................... - < , oth~ g~d~'~ Uce~ ~o ...... ................ ~ ~ ~m~¢r~¢.~m ...... I .... ~.g~ ............. R r... ~.ff ...................... [Da~.:,.r'o..~ House Number ~D~ ~ ~ Street Hamlet County Tax Map No. 1000 Section ~ Block Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy....0..f.~ ! .~..~-....Os.~ .~.. ~v.o ~ ...................................... b. Intended use and occupancy . ~m.~.l.o -X ~.. 2.~. r~.eo..t4a.,.~..~ .~.~,,~5. h.~k. Lu,.~. 2t D. ~ ~.~, 3. Nature of work (check which a~plicable): New Building ..... ' ..... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work./...~,...e-A-w.. .... ' ~ ~..~. ~ CD (Description) 4. Estimated Cost .... ' .t ......................... Fee ...................................... ! '" (to be paid on filing this application) 5. If dwelling, number of dwellingiunits ............... Number of dwelling units on each floor ................ If garage, number of cars .... , ................................................................... 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 ................... i · · Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size of lot: Front .......... i ........... Rear ...................... Depth ...................... 10. Date of Purchase .......... i .................. Name of Former Owner ............................. 11. Zone or use district in which premises are situated ..................................................... 12, Does proposed construction vio!ate any zoning law, ordinance or regulation: ...l~.Ca ......................... 13. Will lot be regraded ........ i ................... Will excess fill be rembved from premises: Yes No 14. Name of Owner of premises .., ................. Address ................... Phone No ................ Name of Architect ......... ! ....... : ......... Address ................... Phone No ................ Name of Contractor .~ 9~3\\~ .~ ..... Address ............... Phone No..?..~.. ) .~...q.q... 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. I '1 STATE OF NEJg/YOgK, .~ l.., ,., ' ' " · .~._~..x,~W_c/~....d.~..~../I,././,~/~/o/~/~ ................... being duly sworn, deposes and says that he is the applicant '~/ ~(Name of individual signing contract) above named. 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 manner set forth in the application filed therewith. Sworn to before me this Nota~ public, ..~ .. Co n No, 4B74~106 - 8ul~*lk COgfl{~ k..) q (Signature of applicant)