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Home My WebLink About534-z FO~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.o 534~ Z Date ............ ][~.~.,~'..... ~ ~.. ................. 19~...~..... Permission is hereby granted to: ~o ~d ~mi t~..~.~..... ~..~.......G..e..o..~ge....~...~.c....~.. ................ .... ~.u.~.$.~, ..... ~,.~., ............................. to ........ ~u~-ld..e~..ad,~i.tion..m%.~'t..exl~ing..d.~e~[ ................................................. at premises located at ..... .~//..~.....~,~..Y...~.~I~..4.~.~.~I~ .............................................................................. ............................................ ,Rey. den...~h,:~as .................................................................................... ................................................ .S..9.~.~.o..~.d..,......~.:.~... ............................. pursuant to application dated ..................... ~.~..~.~b.~.~.......~.~. .............. 19.~..~.., and approved by the Building Inspector Fee $. . 5. .,.. .09. . ............ Building Inspector TOWN OF SOUTHOLD I~UILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLDr, N. Y. / Examined ...... ~. ................................ 19 ....... ,, , . ......... Approved ........................................ 19 ........ Permit No ............... Disapproved e/c .............................................................................................. Application No.....~.']~..~f ................ (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ................ ~ ...... ..~....~.. .................. 19...~..].~... INSTRUCTIONS o. This opplication must be completely filled in by typewriter or in ink end submitted in duplicote to the Building Inspector. b. Plot plan showing Iocotion of lot end of buildings on premises, relationship to odioining premises or public streets or oreos, end giving o detoiled description of loyout of property must be drown on the diegram which is port of this Iocotion. c. The work coYered by this opplicotion moy not be commenced before issuance oF Building Permit. d. Upon opprovol of this opplication, the Building Inspector will issue o Building Permit to the opplicant. Such permit shell be k. ept on the prem!ses ovoilable for inspection throughout the progress of the work. e. No building shell be occupied or used in whole or in part for any purpose whatever until ~ Certificote of Occuponcy shell hove been gronted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuonoe of a Building Permit pursuont to the Building Zone Ordinonce of the Town of So~thold, Suffolk County, New York, end other opplicoble Lows, Orclinonces or Regulotions, for the construction of buildings, odditions or a Iterotions, or for removal or demolition, as herein described. The epplicent ogrees to comply with all opplicable lows, ordinances end regulations. (Signature of applicant, or name, if a corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of ~remises ~ ¢~z~ ...~.*~..~...O....C~ ; If applicant is a corporate, signature of duly authorized officer. ..... ....... ...... ~ (Name and title of corporate officer) I. Location of land on which proposed work will be done. Map No: ............................................ Lot No: .................... Street and Number ..~...C~ ~ I~ni~..~ 2. State existing use and occupancy of premises end intended use and occupancy of proposed construction: b. Intended use and occupancy .......... ~~ .................................................................................... 3. Nature of work (check which appficable): New Building .................... Addition ......... ..~.?~......Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost .................... ~..) ..................................... Fee ................. ~-d .............................................................. (to be paid on fillng this application) 5. If dwelling, number of dwelHng units ................. ../. ............ Number of dwelling units on each floor..../. ...................... If garage, 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 ......... ;~..~ ........... 1 Height ............ ~ ............ 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 .......... ..~m.~...~ ........ Rear ........ ,,-~,..~;....~. ......... Depth ....~..~.. ................. Height ......... ,./...~...~ ......... Number of Stories 9. Size of lot: Front ......../..~.~...*. ......... Rear .......... /...~...~.. ........ Depth ......J~.~ ........... 10. Dote of Purchase ..........-T: ............................................ Name of Former Owner ........ ~'. .............................................. 1 1. Zone or use district in which premises are situated .......... '-: ..................................................................................... 12. Does proposed construction violate any zoning Iow, ordinance or regulation? ~...l~'..,./(~./'.;~.~..c.~...~ ..... ...... ..................... 13. Name of Owner of premises.. ~ ..~'¢~.C,¢~,0Address Name of Architect ........................................................ Address ............................................ Phone NO ..................... Nome of Contractor.~.. '~...~.i~.~..,22-f-r~,~ ......... Address ...,r6~Z4~7(-~,~.~...~.,,(~c..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 numbers or description according to deed, and show street names and indicate whether interior or corner lot. STATE: OF NEW ~OJ~J~, ~/ ) S S COUNTY OF ...~.c. ...... ) .... ~.~./¢~-¢,.~~.~~...~..'./...".(. ............... being duly sworn, deposes and says that he is the applicant / (Name of individual signing application) above n~med. He ~s 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 for~h in the application filed therewith. Sworn to before me th s ~o~ ~,;~ls~ ~o~,,~. /", / - .~ "'~ '~~ ............. d..O., day of ...... ZR~..~... ~.~ i~ ~.,,,ro~ ~o,~(Signature of applicant) Notaw Public .... ~.~~ ......... County ~t~ Mo[cl~ ~o, io TOWN OF SOUTHOLD BUILDING DEPARTMENT SOUTHOLD', N. Y. Exa mined...../~..~...~....[?....~ ........ 19...~...~.. ,,. ...... Approved ........................................ f~ 19 ........ Permit No. Disapproved a/c .............................................................................................. ................................... (Duilding Inspect~' Application No .......~'..~...~:¢' ........... APPLICATION FOR I~UILDING PERMIT D ate ................. .~.../.~...~... ....... .2...~.. ................... 19....,~..?.~.. INSTRUCTIONS o. This application must be campier,ely 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 o 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 k, ept 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 have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of o 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 construction of buildings, additions or a Iterations, or for removal or demolition, 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 wheth,er applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ........... . .~-x~...~,~,..~ ........ ~.~C~(/~..~.~14, ................................................................................... tf 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: ............................................Lot No: .................... Street and Number .............. ~ ............................................. t; .............................................................. ..... ?" Municipality 2. State existing use and occupancy of premis,e,s and intended use and occupancy of proposed construction: a. Existing use and occupancy ....... ~.~ .............................................................................................. b. Intended use and occupancy ................................................................................................................................ 3. Nature of work (check which applicable): New Building .................... Addition ..... ~'~'~i'.i.Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) ....: ............... 4. Estimated ~,os~ ...................... c.~.~. ................................. t-ee .............................. ,~ .......................................................... (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 ......... ..~.....O. ........... Rear ......... ..~...~ ............ Depth ..... ,2,...4. ............... Height ........ /'..fl .............. Number of Stories ............. ~. .............................................................................................. Dimensions of same structure with alterations or additions: Front ............ ?..,~.. .............. Rear ....... ..'-/'....~. ................. Z.2.. t Depth .......... ?...~/..' ........... Height ........... ............. Number of Stories ..... (. ......................... 8. Dimensions of entire new construction: Front ........... ~-.,,.~;z. .......... Rear ....... ?,..,'~-~-.-'. .......... Depth ....../..,~, ................ Height ............. ~..~....°. ..... Number of Stories ..... i(. .................... 9. Size of lot: Front............................/~Z~ Rear .......... ,¢..%.~... ....... Depth ...... ]~ ............. 10. Date of Purchase ..... '...'~..:.r.; .......................................... Name of Former Owner ....-z.; .................................................. 11. Zone or use district in which premises are situated ....... %. ...................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation?///-,CJ~.....~......~.¢,.~,./~..~...~, 13. Name of Owner of premises..~,er-~...t;;)d..~,~,.~.f~....cr'4~....Address ...,~¢.'?-¢,/..4~¢~%....~,..,.~...,...Phone NO ..................... Name of Architect ........................................................ Address ............................................ Phone NO ..................... Name of Controctor.~'~6C/Jc.~Zf.?..~, ...... Address ..~.'~z:/.,.....'.~.'...:(~w..Phone NO. O7.¢.-..~.--..~.~..¢.~.?~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give streeb and block numbers or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW,.,YO~K,,¢ ) S S COUN'r¥ OF ........ ) , ' (..~....,..~......'.c~....-....J.:~, '~..~....~....~.. ........ being duly sworn, deposes and says that he is the applicant ............... application) above named. He is the....~4~.~¢J~.~ ................................................................................................................................. (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 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 . ~o~r~ ~ut~£s.~OWD~I ~.~ ~ C~ ~, ~'~'?1~ ~ of apphcant) Notary P