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Home My WebLink About1086-z FOEM 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? 1086 Z Date ............................ .~0~. ....... ~ ..........19.60.. Permission is hereby granted to: Mtdgley &..Fl~r.ton..A~.C ....... ~o~.oski....~o~ ............ ........ M~ta.P~a~l ................. : ................................ ........... Cut~ho~u~,.....I~.~Y. ................................ to ..... ~.~.L.Z,~......z?.~..~.a.~.o..r....e..a.~.g....b.:.,~.S,~ ............................................................................ at premises located at ...~./.~./.....~. ~U..]~.Q(~..(~[~Q~.). ........... ................................................................. Cutehogu~,.....l~.;~. ........................................... i ...... ....... I~ursuanf to application doted ................................... ~t~,~ ....... ,1,9 ......... 19.t~0., and approved by Yhe Building Inspector Fee $.~,.0.*..0.0.....' ...... TOWN OF SOUTHOLD I~uILDIHG DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ......................... Approved ........................................ 19 ........ Permit No ............................... Disapproved a/c ........... ~.~ ../.....'~..~. .. ............... :z ......................... '~ ................ (Buildin~ Insp~or) / Application No ......... ~ ................... APPLICATION FOR BUILDING PERMIT Date ......... ~1~...~,9 .................................... 19.(~0 ...... INSTRUCTIONS a. Z~is application must b~e c?m,,pleteiy 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 at~p[ication,' the Building !nspector will issue a Building Permit to the applicant. Such permit shall 'be kept on the premises' availabl~ f0r'ihsp~ction throughout the progress of the work. e. No bui d ng shall be occupied or used inCwhole or in part for any puFpose whatever until a Certificat,e of Occupancy shall have been granted by the BulJding Inspector. APPLICATION IS HEREBY MADE to the Building Dep~rtm,~,e. nt for the issuanoe of a Building .P. errgit pursuant to the Building Zone Ordinc~Ce of the Town of South01d, S;ffolk C~)an:~y, New York and other applit:ab[e LOws, Ordinagces or Regulations, for the ~oastruction of buildings, 6dditions or a Iterations, or for 'removal or demolitio~ as'.-~,erein d?cribed. The applicant agrees~ to comply with oil applicable laws, ordinances and regulations. (Signature(~ applic&nt, or name, .~. O corp.?at'q~) ' - ,- ~, .......... O.u,'~,e,J;.to~a~...,~e~...~.c):~,I~ ......... ..:.....~ ....................... (Address of applicant}, .:[ ir State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician:, plumb,~r or builder. ................. Bill,ar ........................................... ' Name of owner of premises ................... '....]~D,~I~..~O~ ........................................................... : ...... -!..~-; ...................... If applicant is a corporate, signature of duly authorized ~fficer. (J~orhe and t~tle of cdrporate office -. ~,i 1. Location of land on which proposed work will be done. Map No: ............................................ Lot : Street and Number ........ ~13g,~..,~.~...g~e,z~Lie;., ....... ...-.;:......~, ......................................................................... 2. State existing use gnd occupancy of pr;emises and intended use and occupancy of proposed construction: a. Existing use and occupancy... ..................................................... :..; ............ : ............................................................ b. Intended use and occupancy..*~..~,~.Cl3~...~al3~ ...... .(.Z.~..a..~'.l13..~e,~.g.~...C~J~]P.). ................................................... 3. Nature of work (check which appllcable): New 13uilding..~ ............... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost.....~...~,..?]. ..................................... Fee ..... ~.Q..,..0.~ ......................................................................... (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 ............................ 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 ......... ..2.~..'. ............ Rear .....2.~,.~ .................. Depth ......~.~.: ................ Height ......8..~ ................... Number of Stories ....... 2. .................. 9. Size of lot: Front .....6...0...~..O..Z'...e.....~..~.:Z'~Pear ............................ Depth ............................ 10. Date of Purchase ........................................................ Name of Former Owner ..}~..:?,~r.....D..O..Z'...O..S..t.C.$ ......................... 11. Zone or use district in which premises are situated .......... .2F.....zt..°.~.e. ......................................................................... 12. Does proposed construction violate any zoning [aw, or~dinance or regulation?~.o.~....tf.9...~r~..~.9.~¢f~-.9..U-.~.e. ........ 13. Name of Owner of premises..D...°.~.°...s..tf.$...B..~.o..~... ....... ~Address .G.'.~;9.~%O.~';.Lkg.~..,i.~.,.~r,^ ........ Phone NO. Name of Architect ........................................................ Address ............................................ Phone NO ..................... Name of Contractor...}~[.2..O-.~.~..e..~...~...Z.[.o..~.Q~ .......... Address ~.t),t~.o.~D4¢~.~.,~.,~. ............ Phone 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 ~...) ' ~,~ i¢~1 ~ ~ ~~ ~,,~J,,,,,:~,~ ....... ~,~ ........... being ~uly sworn, deposes and says that he is the applicant (Name of iMividual signing application) ~_, ,,, above named. He is the .......................................................................... ;~ ................................................................................ (Contracfor~ ~-* ' _~z .... itc.) ,, 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 s[~ ~MO~e ~pplicati~n filed therewith. ...... .~ ........da~f ...... ~.g~,~ ...... m..,~"~'~ ~,~'~ 7Slgnatur~ of appncant) ~ ~. . ~ ~.~lsston ~lres March 30, ~ ~ _ Noto~ Public, ...~~~~.County / ~