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Home My WebLink About10039-Z FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N.. Y. BUILDING PERMIT , % h� .(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ' S OL /-- --N° ®NO* 10039 039 Z Date ....., � -.�rrc„ �2...�. ,...., 19.76 Permission is hereby granted to: ........... �,�,..//... .Cu, ....4 . ................ .......... to .... p. �,�5r? 'l�� ••y{J•C(1 � .... . .(rE] ......ZZ442 .......... .. 4...........777n.................................................................................. at premises located at .,ti1 .5........ 'Intl,., ...� si(,p................ '7'•%�fi�► �!�Gi,i�•� l Y��. ................................................................................ ................................................................................ ................................................................................................................................................................. pursuant to application dated ....A. �.AL� ,�,�...�` ........ 19.7&, and approved by the Building Inspector. Fee $./0.............. Buildi g Inspector FORM NO. Y TOWN OF SOUTHOLD C BUILDING DEPARTMENT O TOWN CLERK'S OFFICE SOUTHOLD, N. Y. N10 Examined .... ....� ........ '194Q t Application No. 12:43.cl............ Approved ..,t.vtvj. ....2. ........, 197 Permit No. ./. .lJ. . Disapproved a/c ....:..........::.. �„�:: -- ................................ ....... ...................................................... t , ............... . ... ... ........... (BWIl ing: I pector) APPLICATION FOR BUILDING PERMIT Date ..7................ 19.(.. .... 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-showirig-location=of.iotland of'buildings on premises, relaf'ionship'ta 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 application. 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 constructiori'-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 buildings for necessary inspections. X ... .. .... ...... ................... ........... ...... (Signatu a of applicaifnt, or norne, o corporation) 4 • jy� ,.1 ...........................,.... ' ....�.........� � ' (Address of applicant) l�Q 3 State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. q� ...................................................:.........................................................................................:.:.................................................. .Name of owner of premises ..............1-A0�-r A�?.......?�1...................................Q~ � :....................................... If applicant is a corporate, signature of duly authorized officer.. - ........................................................................................ (Name and title of corporate officer) Builder's License No. .................................................... Plumber's License No. ................................................ Electrician's License No. Other Trade's License No. .............................................. 1. Location of land on which proposed work will be done. Map No.. ...................::.................... Lot No. ........................ Street and Number .......................��.�4.�..M.!Ps� ?.....2�. . ...........................`-.:. .'f� q? s...... .......... ' - ' Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a Exisiting use and occupancy .................................................................................................................................. b. Intended use and occupancy ......�-�.TC&Ae� �J►�0 vu 6 C=b Q_ GIA(1 OL3 ,ro o`5......,,..,. i, 3. Nature of•work (check which applicable): New Building . ........... Addition .................. Alteration ............,. . . Removal Demolition...'......:.......... Other Work ........................:....................... ... Repair ................. .................. ' (Description) OCA 4. Estimated. Cost w '...............Fee :. .. ............................ (to be paid on filing this application) 5. If dwelling, number-of dwelling units........ ....................Number of dwelling units on each floor ...--...................... Ifgarage, number of cars ............................................................................................................................................ i 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-some structure with alterations-or additions: Front ..............:...................... Rear ............................. Depth ................................. Height ..........:.................Number of Stories ................................ 8. Dimensions of entire new construction: Front ..... ............. Rear ............................ Depth .S?... ? ... HeightNumber of Stories ..:........ .......... ............................................................................................. 9. Size of lot: Front .............� �.. ............... ................. Rear .......................................... Depth �YX!!4:3 .�......... 10. Date of Purchase ...........`/Q. ............. .. ................Name of Former Owner :. v4C(L4'T .......................... 11. Zone or use district in which premises are 'situated .....•.....••.••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••........................••• 12 Does proposed construction violate any zoning law, ordinance or regulation: ...Ai-.4. .............................................. i� 13. Will `lot be regraded, .../yli2.................. Will excess fill be removed from premises: ( ) Yes ()��No 14. Name of Owner of premises .�`�Y�'I�-p� �:..��0. 4..... Address �: A�:v. ..... Phone No..1. -s-9. ...... Nameof Architect ...............................................................Address ................................ .Phone No. ...................... a , Name .of Contractor .................................:.......................... Address ................................ Phone No. ...................... PLOT DIAGRAM Locate clearly and distinctly all 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; r Y_ , O v+ 10, C> - o e s STATE OF NEW-JYO I S.S COUNTY OF .............. being .duly sworn, deposes and says that he is the applicant ae of individual signing contract above nam Heis a ............ .�� .. .... . :...;............................ .. . .......................................................................... (Contractor, agent, corporate of i r, etc.) of sai 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 ore true to the'best of his knowledge and belief; and thar the work will be performed-in the manner set forth in the applilcatioh filed therewith. Sworn to before me this ..... . {.,•..� ay of ��q 6"�.. .., 19.2. 7 Notary Public, . . . .. .. . . .. .`: o ty ........ .. . .................. �- (Signature of opplicont) PAMELA J. SCHINELLER NOTARY PUBLIC'S'ale of New Yo No.466!300 Oualified in Suffolk Counly C,7 m4,icn fz•-i—March 30,