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Home My WebLink About693-z FOI~M NO. 2 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.° 693 z Date ............................... ...1~.......2~.. ............ 19...~..?.. Permission is hereby granted to: WSLlJum...We~-.t~nbar~ ........................................... ................ ~i~t~'~u~ki'" ..N~.~ ~. ............................... to ...... ~d~.~e~..o~e. at premises located at ......................................................... ~ttLtu~.~...~.T. ........................................................................ pursuant to application dated ................................. ~'.......~,?. .............. 19..~..., and approved by the Building Inspector Fee $...10.,00 ........... Building Inspector FO~M NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ............... ~.¢,,~.,~ 19.~.. Approved .............. .,~ - ...¢~.19..~ermit No ......... ~.....~....~'.~.. Disapproved a/c ..................... ~...........~ ......... ~=z .......... ~ .......... Applicet on ........... (Building Inspector) APPLICATION FOR 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 co~ered 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 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 construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. . .W_i..1.~ Wertenber~ (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 ....... William ~ertenberg If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Location of land on which proposed work will be done. Map No: ....WerJ:,el~berg .................... Lot No: ..?. ................ Street and Number ~N./~..~.F...e~..~.H..e...~.].~.e.~w.~R.~'e.a..d.~.~..M~'~.t.;~.t..~..~: ........ Municipaii~y ........................................................................ State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and o ..... ant,, Vacant land b. Intended use and occupancy .................. .d..w..e..1..1..'..z~g.. .............................................................................................. 3. Nature of work (check which applicable): New Building ......... 'I~ ....... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost........]~..~..0...0~.. ............................................ Fee ....~..0.:..0.9. ............................................................................ (to be paid on filing this application) ' .5. If dwelling, number of dwelling units .......... em ............... Number of dwelling units on each floor ............................ If garage, number o( cars ..............t~lte ................................................................................................................ 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 same structure with alterations or additions: Front ................................ Rear ................................ Depth .............................. Height .............................. Number of Stories ................................ 8. Dimensions of entire new construction: Front ........ ~. ................ Rear ...62 ..................... Depth ........ ;21~ ................ Height ............................ Number of Stories .....e...l~.. .................. 9. Size of lot: Front ......... '1~2o8 ......... Rear ............ ].3~, .......... Depth .. ..].. .?.0. /.. .].. ?. .0. ......... 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 1 I. Zone or use district in which premises are situated .......................... .~,k.e...d~l~:t, .................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ................ .~..e. ................................ 13. Name of Owner of premises...~...~..e..r..t..q.n...t~..r.g ............ Address ............................................ Phone NO ..................... Name of Architect ........................................................ Address ............................................ Phone NO ..................... 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 numbers or description according to deed, and show street names and indicate whether interior or corner lot. 0 IJF' L T/ rE OF NEW )~O~,,~J ) S S (Name of individual sign~;~i~)~ ~ 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 this application; that all statements contained in this application are true to the ~st of his ~owledge and belief; and that the work will be performed in the manner set fo~ i~_~p~ion filed therewith. Sworn to be~ me this ' ~ -- ~ "°~2'°3449~0"c' a3's~Uf%f°l~ec~u~ I ~ ~ . . ~/~ .... ~mm,~ion ~ires ~arGh ae~tur_ _f a .... nt~ ~, gOP~M NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y, Approved ................. . perm,t .......... V~so~p~oved o/q ,....~,..~.,~ ............ ~...,: ..... ~.._,~ ............... (Building InspSctor) 7_~ ~' ~/ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted [n duplicate to the Building inspector. b. Plot plan showing location of Jot 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 premlses a¥oiJabJe for inspection throughout the progress of the work. e. No building shall be occupied or used in whole or in p art for any purpose whatever until a Certificate of Occupancy shah 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 construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicdnt agrees to comply with oii applicable laws, ordinances and regulations. (Signature of applicant, or name, if o corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ................................................ % .................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and tide of corporate officer) 1. Location of land on which proposed work will be done. Map No: ....?~'~t~.lc.~.?g ..................... Lot No: 9 Street and Number N/('~ ~o.~, ,{o~,,o~ P,o~ct~ ~¢,,~xtO~ . Municipality 2. State existing use and occupancy of pr~mises and intended use and occupangy of proposed construction:' a. Existing use and occupancy ..................................................................................................................................... b. Intended use and occupancy ................................................................................................................................ ,/ 3. Nature of work (check which applicable): New Building ........ ,j~ ....... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4, Estimated t~ost .............................................................. rea .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units .......... ?,t!~.. ................ 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 typo of use .............................. 7. Dimensions of existing structures, if any: Front ............................ Rear ............................ Depth ............................ 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 ........ ~: ................ Rear ..~ ..................... Depth Height ............................ Number of Stories ............................ ~'~ ~ 1..¥~ ......... Depth I?(;/ 9. Size of at Front ........ ~R~Y ..........Rear ............................................... ]0. Dele of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ................................................................................................ 12. Does proposed construction violate any zoning iow, ordinance or regulation? .................................................... . ?,~ ?~,:~" ,oztocsz & --"res .................... 13. N~me of Owner of premises ........................................ ~d s ............................................ Phone NO, Nome of Architect ........................................................ Address ............................................ Phone NO ..................... N~me of Contractor .................................................... Address ............................................ Phone NO ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate al) 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 YORK, ) S S. COUNTY OF ............................ .................. i .............................................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ................................................ i.~.~.~¥~,.~'~;"~;.'l~;.'~'~"~.:~i~',"~'(~]i ........................................ of said owner or owners, and is duty authorized to perform or have performed the said work and to make and file this app ication; that a I statements contained in this application are true to the best of his knowledge end belief; and that the work will be performed in the manner set forth n the application filed therewith. Sworn to beforb me this ........................ day of ........................................ 19 ............ (Signature of applicant) Notary Public, ............................................................ County