HomeMy WebLinkAbout21842-ZFORM
TOWN OF $OUTHOLD
BUIt. DING DEPARTMENT
TOWN HAU.
$OUTHOLD, N.Y.
N_O
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
o,e .............. ............................
21842 Z
Permission is hereby granted to:
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to . . . . ~ . ,~. . . . . , ,o. . .I. . : ?. . ........... ~. . ~ ........ ~. ~. . . . .~. . . .>.z. . ........... ::. . .~ ......... tJ ~ ? .................
CounlyTax Map No. 1000 Se¢flor~....~ ............ Block ....... .~..~.. ............ LotNo ....... &~,. ............
pursuant to application dated .......... .~...~.'~.~..., ......... ~ ........................ 19....~...~.. ...... and approved by the
Building Inspector.
~ s,,..2..~.:.~,.,
/ Building Inspector
Rev, 6/30/80
~3. Nature of work (check which applicable): New Building ~. ........ .Addition .......... Alteration ..........
Repair Removal .... Demolition~x<,..: ......... Other ~i~ ...............
.................. · ' :' '.' ' ~' (Description)
4. Estimated Cost .~./~./~,e '
.................................... 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 ........................................................................
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 ., .7..d2..~ ....... Depth . .~.O: ..........
Height ....2. ,L_. ........ ~umber of Stories ..... ~ ..................
Dimensions of siame structur,~ with alterations or additions: Front .... ........... ~/.~.. ' ....... ixear~ ..... kvS;~:~'..,r .............. ............
Depth .... ~.~. ~. .............. Height ........... ' ........... Number of Stories ....... .
8. Dimensions ofentire new construction: Front .... ¥ ......... : Rear . .'Sr~.' ......... Depth . .5/~. ..........
Height -g-~ / . Number of Stories ~.. ., ..................
9. Size of lot: Front ................... ~.. Rear ...................... Depth ......................
10. Date of Purchase ............................. Name of Former Owner .............................
11. Zone or use district in which premises are situated .....................................................
12. Does proposed construction violate any zoning law, ordinance or regulation: . ../~.Q ...........................
13. Will lot be regraded ...a~. ~.: ...... ~, ............. Will excess fill be removed from premises: Yes
14. Name of Owner of pr,emises .~e.*..,~g..a/../~),/ ....... Address , ,~..4~t,,eT. z2 ~g)~....... Phone No. ?~f. ;.~. ~..;.
Name of Architect ?.,(..~j ~./C,~. ................. Address ,/~?..~5/.4~.'t~..~'a~ff. .... Phone No..~.7..2.?.yq <, .....
Name of Contractor ~.¢.'2~..~/.o./.,'~gq..',P?.~.~. .........Address ~.d~.~./3~')~.~'.~.~..,... Phone No. :7.1,.f'.?...e.q?..' ....
15.' I.s this property within 300 feet of a tidal wetland? *Yes ........ No.~. .....
· If yes, Southold Town Trustees Permit may be required.
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions frc. m
property lines. Give street and block number or description according to deed, and show street names and indicate whether
interior or corner lot.
sT^-re oF N~w~v-OR~7__.//~/~ s
COU~?-'5 9fr ~c~'-r~'_z~.~'~'~' ~' /
.... .... .........
(Name of individual signing contract)
above named.
being duly sworn, deposes and says that he is the applicant
of smd owner r o , id work and to make and file this
~pplication; that all statements contained in this application are true to the best of his kn.owledge and belief; and that the
',york will be performed in the manner set forth in the application filed therewith.
~worn to before me th/s 'Ix, ,
.............. ....... .....
...... County ~, '' ~.. ..
· CLAmE~ ~t~. · ~'~.~, .' .............
m=,.t ~,i~. mat. o, N~ Y~' . .... ~~' -~-~ .....
No. 4879508 ,~ .dr (Signature of applicant)
Otm~if ed in Suffolk Couqty
Commission Expires December'8, 1