HomeMy WebLinkAbout950-z FORM NO. z
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE K PT ON THE PREMISES UNTI ULL
COMPLETION OF THE WO- AUTHORIZED)
N° 950 z ....�an�.....6........... i .....
Permission-is hereby granted to:
List. ..xs. 'i?....�. .. ......4�1..........
Fos le Av
............ ..................................
to .893 lin ..... ....................................................................................
at premises Iota d at .hod Acret+......................:.......................................................
Prve
................................ . .. .... lGR ..... �: ..f..... t.�lO f.... �T ..............................................
pursuant to opplicotion date ........................reecmber. .30.................19..... and approved by the
Building Inspector
Fee $ A..►7�....p�4 !i, check
Building Inspector
FORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
NOTICE OF DISAPPROVAL
To IAd o.. ~ .on ~.~r~.c~;LO~.....~.,....-~..t.t.n. ~A .1..b..e.~..~er guson
.Roee.vaZe..A.ve .................................................
· Ronko~o~e,~... L,~..,.... ~ ~ ..........................
PLEASE TAKE NOTICE that your application dated ................... 11/...21 ....................... 19..~c~..
for permit to construct ..~..w.~.~..~.~..n.g ........................ at the premises located et
...................................................................... Street Sour, hal.ct ~ N,Yo
Mop ...~. I~..~.g.o..d...~,.q..r.~..s ........... Block .....s..e..O..t.~.o..n......~. .................... Lot ...]'..~. ...................................... is
returned herewith and disepproved on the following grounds ..... ,T~.t~'~.~lo::!Le~,t.'~..~:Lde..~.~.d..or~ ....
....... t~o~"~,he~-ly..e~.de. ·. ~r~t. · .no..ff. ee..e~e~&sed., .... .............................................................................
Building Inspector
FOEM NO. I
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN GLERK'S OFFICE
$OUTHOLD, N. Y,
APPLICATION FOR BUILDII~IG PERMIT
INSTRUCTIONS
a. This application must be completel,,y 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 be.fore 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 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.
....................
(Signature of applicant, 6~ name, if o corporation)
..... .......
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
~ ....
N me of of ........ ...... ................................................................
If applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate, officer) ,~;,¢:.t.-/- /
1. Location of land on which proposed work will be done. Map No..:1~: ...... ~..~..~KI.. ............. f%Lot ,
Municipali~
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ......... ~.~.~x<-8,,~ ..................................................................................................
b. Intended use and occupancy .......... ~'~.~z~'f~4.:~-~ ....................................................................................
3. Nature of work (check which applicable): New Building .................... Addition .................. ~..Alteratton ....................
Repair ........................................ ~ Removal ~"~ Demohhon' ' .................... ' *'""'"- Other Work (Describe) ....................
4. Estimated Cost .......... ........................... Fee ....,~,.../.....6....~ ................................................................
(to
be
paid
filing
this
application)
on
5. If dwelling, number of dwelling units ....... ...J. ....... : ....... 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 ............................ Depth ................................
Height ............................ Number of Stories .............................................................................................................
Dimensions of same structure with alterations for additions: Front .................. '.... .......... Rear ................................
Depth ................................ Height ................................ ..~" Ndmber of Stories.t,~ .......~ ........... ~ ..........
8. Dimensions of entire new construction: Front ....~...~....--.. ............Rear ...... r?..!:......'~..........'Depth .... '.~ ..............
Height ...... 1....%.~'.. ............ Number of Stories ................................
· ....
~. S,ze Of lot: Front ..~/.~,,'~ ......... ~,,, Rear ...../,.,?~ ................ Depth ............ ~ .......
10. Dote of Purchase ... ~..:../.Z...'....,~,__ .............. Name oF Former Owner ~ ..........
11. Zone or use district ~n which premises are situated .....................................................................................................
i2. D, oes' proposed construction violate any zoning Jaw, oj'd nonce or regulation? .... .,~.~....~ ............. ~.~. ...........
Name of ^reh teet NO, ....................
Nome of Contractor ~(~ ......... ~..~...~.~l~ddre~s ...../..~~. Phone NO .....................
PLOT DIAGRAM
Locate clearly ah~ .distinctly all rbgi,ldings whether existing or proposed and indicate oil set-back dimensions from
property lines. Giye 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.
COUNTY, OF .......................... ),
~.'i(~," ,,,~~ ............ ;..beihg doIy' sworn, deposes ond'~says that he is the applicant
(Name of ind~wdual sig~lTnb appTication-T
abow~ named· He is the ........ ~;~ .............................................. ;V: ............. f .......................................
~ontractor, agent, corporate ~ttlcer, etc.)
of saJ~' owner or"owners, and is duly authorized to perform or have performed the said work and to make.and file
this application; that all st~ements contained Jn this application, are true to the best of his knowleSge and belief;
and that the work will b~eqformed in the manner set forth in the application filed therewith.
Sworn to~efore me thi{///j //~
'
Notary'P.b',c ..~.~;~.~~ou~ (S,gnature of ap~c~h~
DRN.
I~IC~4.°O~.'~O~Vd I00.00
LOT /.,.-~
MAP O~==
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TOVv'IV O~c ._~OUTHOLD / SUF?OL/C
.~OA LEI ": o~,O'
L eon¢rcf V. CA4¢ry va~e/ .~urv. Oc/ ~
svRwrrv fOR: £/dO Cona/r~/c//o/~ Cor~ I
B. J. BOLENDER, JR.
LAND SURVEYOR, LIC. 33112
CELLAR
SHEET NO. I
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