HomeMy WebLinkAbout154-zFORM NO. 2
TOWN OF SOUTHOLD
BUiLDiNG DEPARTMENT
TOWN CLERK'S OFFICE
SOUTI"IOLD, N. Y.
(THIS PERMIT MUST BE KEPT ON THE PREMISES---__ .._-....'~[J*T~*(~F~-~T~OJc
,~.(~Ft~?~.~S.~'J~..~F~[~C.~i,T'~(~,UNTIL FULL COMPLETION
OF THE WORK AUTHORIZED)
No... [..~ ~ ......... Date ..... :;"Oe'tO~' '" '~ .......................
Permission is hereby granted to:
A. ...........
.... ~he"~Lomi~g ..................................................
............... .~ $ s. h e r s. . . .T z.Z. e~,~el, t. . . t~ ~. ~ ~ .................
to ..... Bu~*~¢]***an* *edd~L*~Lon** *to***e~ct~tt~g* * ~t*~*dti~ ............................................. ~ ...........
ot premises Iocotecl ot .............................................................................................................................
pursuant to application dated ........................ O~.t~'l:~,,/~ ....................... 19..~'~., and approved by the
Building Inspector.
Fee $'"'~'; O0 ...........
CARPENTRY
PLUMBING
PAINTING
RBFRIGERATION
TELEPHONE Fo I. 231
A. JOHN GADA
Member Connecticut Society of Civil Engineers
General Con,racking
P. O. Box 330 Fishers Island, N. Y.
ELECTRICAl. WORK
ELI~CTRICAL AND
GAS At~PLIANCES
ROADS AND GROUNDS
Agent for Bottle Gas, Petro Oil Burners and Pittsb~trgb Pab~ts
October 229 1957
Mr. Howard Terry~ Building Inspector
Town Clerk's Office
Southold, Long Island
New York
Dear Mr. Terry:
I am enclosing herewith Form Noo~ Application for Buildlng
Permit in duplicate~ together with my check for $5°00 to cover the
cost of the fee for this permit.
AJG/ec
Encl: (3)
FO~ NO. I
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Approved ........................................ 19 ........ Pen'nit ...................... ~ ..........
Disapproved a/c ....
............ ......... ................ T .............
APPLICATION FOg BUILDING PERMIT
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building
Inspector.
b. Plot plan showing location of lot and of buildings 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 location.
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 progress of 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 hove 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 l'own 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 lows, ordinances and regulations.
,~'Z JOHN GAD~~,
(Signature of applicant, or name, if a corporation)
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrican, plumber or builder.
.................................................. ~.e.p.e.~.t.,.,c.,o.p.t.~.c.;f.q~ ..........................................................................................................
. ~ez'y Yo Edmonds
If applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate officer)
1. Location of land on which proposed work will be done. Map No ................................... Block ..................................
Street and Number lq ~¢z'].an Avenue
State existing use and occupancy of premieses and intended use and occupancy of proposed construction:
Ex, t,,g ,se ond oao,panc;, .......
................. .............. ...................... ~ L:..................... f . ............
b. Intended use and occupancy ................................................................................................................................
3. Nature of work (check which applicable): New Building .................... Addition ...~.x. ............. Alteration ....................
Repair ....................Removal .................... Demolition .................... Other Work (Describe) ....................
4. Estimated Cost ...$..1..t.0..0...0. ............................................. Fee .~,.C~0. ........................................... . ....................................
(to be paid on filing this application)
FEES:
5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................
If garage, number of cars ........................................................................................................................................
6, If business, commerJcal or mixed occupancy, specify nature and extent of each type of use ................................
7. Dimensions of existing structures, if any: Front ..........
.................. Rear ............. ~ ............. Depth 25'0"
18' 0"
Height ............................ Number of Stories ....... ~% ...................................................................................................
Dimensions of same structure with alterations or additions: Front ......... ;~?.0.". ............. Rear ..... .4.&~.O.". .................
18'0"
Depth ............. .2.~.,0.~ ....... Height .............................. Number of Stories ...............................
8. Dimensions of entire new construction: Front ......... J].~. ............... Rear 8' Depth 10'
Height 8' Number of Stories !
9. Size of lot: Front ?2.8? Rear 78.8 Depth 85.6
]0. 7one or use district in which premises ore situated .................................................................
] ]. Does proposed construction violate any zoning law, ordinance or regulation?.....Ntl ...........................................
,~, .... ~ Mary Y. Edmonds ---,o~ Fzshers Island, d.¥o Phnn~ , ...................
]2. Name of Owner ,,. ~, ................................................. ,~aa .......... ; .......................................... NO.
Name of Architect ...................................................... Address ............................................ Phone NO .....................
Name of Contractor....A.~,..ff~?bD...~.a..d..a. .........................Address .F.$.sb~,r.$...i.~.l.~.d.,...N,.Y. ..... Phone NO....233. ...........
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 numbers or description according to deed, and show street names and indicate
whether interior or corner lot.
COUNTY OF.~'. ............. ) S S.'
A. gOl~ GADA
................................................................................................ being duly sworn, deposes and says that he is the applicant
(Name of individual signing application)
th- ¢ont~cto~ ..........................................
above named. He is __~ ................................................................................................................
(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 oil statements contained in this application ore 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,~.~ ~--~t° before me this ~
... ~1.~,--: ............ day of ......................................
(Singature of applicant)
. . ~t~. ~ , ~ t~
Notary Pub ~c,...~~...~....~.~ ....... Coun y ~LOISE BOWD~fl
~ public, State of New
~y OommJssiml Expi[es March 30,
3. Nature of work (check which applicable): New Building .................... Addition ...3..x. ............. Alteration ....................
Repair .................... Removal .................... Demolition .................... Other Work (Describe) ....................
4. Estimated Cosl' ...$.~..,.0.0.9 .............................................. Fee .$$,,.0.0. ...............................................................................
(to be paid on filing this application)
FEES:
5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................
If garage, number of cars ........................................................................................................................................
6. If business, commerical or mixed occupancy, specify nature and extent of each type of use ................................
7. Dimensions of existing structures, if any: Front ........... .3.~J....0. JJ ..... Rear ..... .3..5..~.].0.'.' ........... Depth .....~.5..'..0..'J .............
Height .......... 1:.8..'..? ......... Number of Stories ......... ;~ ...................................................................................................
Dimensions of same structure with alterations or additions: Front ......... 35LOJ! ............. Rear ..... .43.!.0.':. ................
Depth ............. .2..5.?.i: ....... Height ....... .1:.~.~..0..'; ............. Number of Stories ...........~.~ .................
8. Dimensions of entire new construction: Front ......... ~3.~. ............... Rear 87 Depth
Height ........ ~'. ................ Number of Stories ...J, .......................
9. Size of lot: Front ..~.....7.~..~.8..7 ........... Rear ..... .7..8..,..8. ............... Depth ........ :.8..5..:.6. ...........
10. Zone or use district in which premises ore situoted ................. Z ......................................................................
l l. Does proposed construction violate any zoning law, ordinance or regulation?.....bJ~ ...........................................
12. Name of Owner of premises....M.~.z..¥:.¥.:..~.d...m.9.~)..d..s ....... Address ...F..~..s. J2.e.?..s...~.s.l.a..n..d.;....N..%Y..:..Phone NO .....................
Name of Architect ...................................................... Address ............................................ Phone NO .....................
Name of Contractor...A.....J. oh~.~..Gacta ......................... Address Ekskez:a..Ia].and,..N.,.Y ..... Phone NO....2~.1 ...........
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 numbers or description according to deed, and show street names and indicate
whether interior or corner lot.
STATE OF NEW~ YOR,K,, .~ )
COUNTY OF~.~.,~..i~:'.r-.~...~..~:~':.~-.) SS.'
A. JOHN GADA
................................................................................................ belng duly sworn, deposes and says that he is the applicant
(Name of individual signing application)
above named. He is the ...... .c..o..n..t.~.a.~.t..o.?. ................................................................................................................................
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly ~uthorized 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 ~ ~' day of
Notary
(Singature of applicant)
I~R Public, State of N~&~ ¥ot~
esiding in $~ffo~k Gount¥
~ CommJs~!b~ 1~x~ires Nlarch ~0, ~9,~ ~
FOItM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
$OUTHOLD, N. Y.
xam,ned ........ .......
Ap raved ..................... !! ................. ........ .....
Disapproved a/c
(Building inspector)
Application No ./jr--.~/:
APPLICATION FOR BUILDING PERMIT
Date October 22~ 1957
INSTRUCTIONS
o. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building
Inspector.
b. Plot plan. showing location of lot and of buildings 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 location.
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 o Building Permit to the applicant. Such
permit shall be kept on the premises available for inspection throughout the progress of the work.
e. No building shall be occupied or used in whole or in part for any purpose whatever until o 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 Pernqit pursuant to the
Building Zone Ordinance of the Town of Southold, SuffoH¢ County, New ¥'ork, and other applicable Laws, Ordinances or
Regulations, for the construction of buildings, additions or alterations, or for removal or demolitlon, as herein described.
The applicant agrees to comply with all applicable laws, ordinances and regulations.
(Signature of applicant, or name, if a corporation)
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrican, plumber or builder.
General Contractor
· ~ Mary Y. Edmonds
Name of owner of prem,se .............................. . ..
If applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate officer)
1. Location of land on which proposed work will be done. Map No ................................... Block ..................................
Street and Number ........ g.u..e..s..t.Z.%.~.n.....A..v..e..n.u...e ........................................ ~,.'..~¢~.,,M....,=~/.~,~,.~,~.~.z(, ................
2. State existing use and occupancy of premieses and intended use and occupancy o'f proposed construction:
a. Existing use and occupancy ...... .B..e..a..u.~.y..?..a.~.l...o.~...~.n_c]...G..~..¢~...8..h..o.p. ......................................................................
b. Intended use and occupancy ........ ~ ............ ~ ................... ? ........... '.'. .......................................................................