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Home My WebLink About969-z FOR, I~ NO. 2 ' '~OWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE . SOUTHOLD, N. Y. BUILDING PERMIT N? (THIS PERMIT MU~T 8E KEPT ON THE PREMI~ES'0NTIL FULL' COMPLET.ION OF THE WORK AUTHORIZED) 969 Z Permission is hereby granted to: ~bert De~-~... ~/~,.. :~e~'.~¢~...T,~dd e ............. ' ..................... .............................................. to 8.~. ~e~..~e. ~_~1~. A~e~g .................................................................................................. at premises located at ..~.,~..~....~,~.~..~G~..~~ .......................................... ...................................... ~/5....~.~p~..~6 .............................................................................. ...................................................... C~¢c~,..).,~ ............................................................... pursuant to app[ication dated ................................ [eb~....~. ........... I~.....,, and approved by the Building Inspector Fee ~..O...._O~......~....~.d....- ohe~k · ...~...T:.~:~:...: ......... : ........ ?::;.'Y.~ ....... i'f. ................... Building Inspector FO]EM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exam,ned ...... Approved ..... ~//***~ ......... =.~..'...,., }9.~..,**Perm~t ~o ..................... ~ ........... ~sapprovea a/c ..~....'...~....:'.:.' ....................... ~F..' ...................... ~...: .......... ............... .......... .............. ........ (Buildisg inspector) J Application No ...... ~...~.....~. ............... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in init 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 ma,,, 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 ava,iloble for inspection ~through0ut 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 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. 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, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electriciao plumber or builder. Equitable owner as pu~ohase~ under cont~act~ dated January 22, 196b~ also agent f. ~..,1 e~al., ownmz,....f.o~', dpu~.p ~s e~,,. hene 0f. Name of owner of prem ses~.~...e.f~.~."~P.~`~..~.~.~]g.?...e~.~~~.~?~.~.~..~..~..~..~e..~..~.~.~..~.9~;!~!~ ...................................... 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: ....... ~,,~.6. .............................. Lot No:......~..0.. ....... Street and Number .~.~...~g..~.?'~..~.'~.~.~.~u..~?..~...~..~...~....~.~.....~....~...~..~..g~e..~.~..~.t.R...~.~.~..~.~ ............ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy Vao~t b. Intended use and occupancy ..... .~...~.'e.~..~/~...~T.~.1.~...~.d~.e.~..1.~..~.~.~.~.g*.~..e.~...)~.~....~.~.~.~. ......... 3. Nature of work (check which applicable): New Building ....]~ .............. Addition .................... Alteration .................... Repair ................. ~.Removal .................... Demolition......~,. ........... Other Work (Describe) .................... 4. Estimated Cost ...... I.~...~...°..¢k. .................................... Fee ../...0.. ................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units......O..~..,e. .............. Number of dwelling units on each floor .................................. If garage, number of cars......~....~..~..~..~'~'~..`~...~.....h..~...~..e...~.~;~..~..~..~.~h.e..~...~'~.~9~.~.~9 ......................................... 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 ......... .,,~'...o. ............. Rear ...... .?~...O. ................ Depth ....~..O...t, ................ Height ...I...~....-....~ ........... Number of Stories.......(~....e. .................... 9. Size of lot: Front ...?.6...l...~ .............. Re_ar .~..,v.~.~ ........ .. ..... Depth ~9.~.~....O..~....~,[...~9'~10: ri. ~ue~a~ O~nez, ~oez~e~' pitt, e 10. Date of Purchase .ohaeed...Se_m~,.~,~...~,95~ ........... Name of Former OwnerM...a.~.~1.9.~...~..e....~.:....~...~..0.~..~....~. ......... 11. Zone or use district in which premises are situated.~..A..~.~..'e..~.~.~d.e~.~..~...~..~..%~.~.~...A~.."~..~....%~..'.t~...U~....~..~. ............................... 12. Does proposed.con~tcuction violate any zoning law, ordinance or regulation? .....Y..e...S. ........... ~ ............................... ,. 13. Name o~Owner of premises..:'...'~'..;...¥.tM...z~... ................ Address ....~.O......~......,,.....N,:...... ....... Phone NO.630~ ........... Name of Architect~tl:-~...l~.,...~,~4. D.~.R$ .......... Address ..~or~F,~.-'c...H4.t.',,~.,..~..'f... Phone Nu ..................... 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. STATE OF NEw Y. QRI~. ) S.S. COUNTY OF .~...'~,..:~..O.~ ........ ) ~.8~I, ON T'A~ . ~ be n duly sworn, deposes and says thatl~e is the applicant (Name of individual signing application) above named.~e is the .e~.1~&b1~...~r~...a~id~..a~e~..~f...1-eF~a1...~wr~e~..~...~..D~.e~ .............. (Contractor, agent, corporate officer, etc.) ~___m3~1110¢ 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 manq,~L~tF.fo6X~in the application filed therewith. Sworn to before me this No. 52~5922700 Feb~u~--' ..... 9..~..h. ............ day of Notary Public, . .............. ~ .......................... County (Signature of applicant)