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Home My WebLink About14580-Z l~OW~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.o 14550 Z Permission is herebf granted to: ....... ~z~.....~.~ ....................... ...... .~?...~.~.a~.~...f..~ ........................ ...... .Z...~.,~.~,..~=~....././..~.~ ,o ......... ~~.~.~......~.~.~.....~...~~ ..................... ........... ~/~.~ ............................................................................................................... ot pre.ises I~eted ot ....~ ....... ~~...~ ................................... ..................................................................................................... co~ ~o~ ~o~ ~o. ~ooo s~,o~ ...r.~.7 ....... ~k ...~...~ ...... co~ so....0.~.~. ...... Building Inspector. Building Inspector Rev. 6/30/80 ;) ; / 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN ,ALt. SOUTHOLD, N,Y, 11971 TEL.: 765-1803 ........ ...... APPLICATION FOR BUILDING PERMIT 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 buildings on premises, relationship to adjoining premises or public streets )r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- ;ation. 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 ;hall 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 ~hall 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 8uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or [~egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. fhe applicant agrees to comply with ail applicable laws, ordinances, building code, housing code, and regulations, and to ~dmit authorized inspectors on premises and in building for necessary inspectjs:~&,~ ,~ ~ (Signature of applicant, or ngme, if a corporation) .. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...... .0.~.n.~ i,.. Name of owner of premises ...... g. 1. 0 .e.r.~.. ~ ~.i.~ $...~...~.A/~./..~?.~. 4~..../~.e'./.~?. .............................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No.)(, ...N ./.fi. .................. N,'% Plumber's License o ......................... Electncmn s L~cense No.~ ...................... Olher Trade's License No ...................... 1. Location of land on wlfich proposed work will be done .................................................. Count Tai~i';'o''l~'~;ilt'i'i 11; ..................... " ............. Y P · 'o - -~ ................ Block .../4 .~. 5..) ........ Lot .(.Pc.]-.)..2.1..& .~6.~.... Subdivision ..................................... Filed Map No. ::~] ......... ], Lot .......... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... .R.q~.O.e.q~$ ~,1... $,ing].e.-f~.m1.~_y b. Intended use and occupancy "J~e.~ ~ O.e.q t $~2... $ :[ jn.g l'¢.-iF.a, r0 J, ~[ y.../5t'~-J,~....~.,..~'...~...~..qf.~.-.~.~.. 3. Nature of work (check which applicable): New Building . ' .....'A2;tdition .......... Alteration ........ Repair . ;... :,~ ...... Removal .............. Demolition . .s~... 2< ........ Other Work ............. /~5'-7ff'~ l~fffr~'o (Description) 4. Estimated Cost .... .$..6.0., .0.0.Q ...0.0 ..................... Fee .. L ff-.'~...~ .... ~..~... 7../..~..&. .... (to be paid on filing this application) 5. If dwelling, number of dwelling units ........ 1 ....... Number of dwelling units on each floor .... 1. ......... None if garage, number of cars ...................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use 7. Dimensions of existing structures, if any: Front... ~..&'7.. ~.-.~.... Rear .. Height .... /]. t . Number of Stories Dimensions of same structure with alterations or additions: Front ................. Rear ................ Depth ...................... Height ...................... Number of Stories .................... 8. Dimensions of entire new construction: Front . 30 ' Rear 27 Height .......... 17 ' lXh,mh,r nC ~:*,,~,c 1 9. Size of lot: Front .. ,5 ................... Rear .... ./4.9...8. '. ............ Depth ,..2. QO:. 10. Date of Purchase ./4.22 ....................... Name of Former Owner .~fi.5. ~9r.>.' .~.'...~..g~.; .~.'../-Xt.e.C$?... J. Zone or usu diahlct in which pseuuses are sa£uated ......... : .................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ..................... ~ .... 13. ~ill lot .be regraded ...'~.~'.--q~.;~.. 2(..3~'~.¢ .......... Will excess.fill be re~)~ved from premises: (~_~_~) i' 14. Name ol Owner of piemises/.! .... ' ............... Address ,5'.~..~.¢r~r. . g~ . Phone No.,:~./6.-'~. · ..... Name of Architect ........................... Address ...~.,(,y.~.a..,:y.~../~.~' ..... Phone No. ,. ?-..q?7.7.('e.~.. Name of Contractor . .R.q b. 9.r.t-...H.e.r.rfi. 1..1 ........ Address E.a..s.'c..H.a..m.t.o.q ~ .N: y... Phone No.(.5.1.6. !..5.2.4. 7.5.': PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions frc property lines. Give street and block number or description according to deed, and show street names and indicate whetl; interior or comer lot. STATE OF NEW YORK, S.S COUNTY OF ................. ·../~.~ ~-~.,3..7-./'~, ~(Je','.5~.. ~ ..................... being duly sworn, deposes and says that he is the applican (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 thi application; that all statements contained in this application are true to the best of his knowledge and belief; and that th work will be performed in the manner set forth in the application filed therewith .... Sworn to before me this ....................... day .......... 19 Notary P~ic ~.~. ~(~ County . '"7 ..... ;"~' '; ............ ' /qT&,L3/V - ...... ~7~'7'?'b1~'~')'~ (')~."7 ...~/~/~.~ _. (Signature of applicant: