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HomeMy WebLinkAbout1560-zTOWN 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? 1560 Z Date ........................ Permission is hereby granted to: ........ ~o~tt~o[L¢~ ..................................................... to .Bn.t~d.....nex¢..one.. ,ti. ami l.~.. ~,we.]~ 1.lng. .................................................................................. at premises located at .~/.~...,..C)~7,4~od,,.D~.i.~.e ................................................................................. ........................................................ Seu.~he:id ..................................................................................... pursuant to application dated .A'z*J~er~ed. ....... O~to~el~......]:c/ ........... 19,.6.%., and approved by the Building Inspector Fee $. lO~.OO .......... FORM NO~ 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................ .~.: ............. , 19..i!....Permlt No.-~ / ~f'~ 0 Disapproved a/c ................................................................................. ~:: .............................. ~.~ .......... ::~; ............................................. (Building Inspectort APPLICATION FOR BUILDING PERMIT Date ....................... ~.t. obez~.....t.~ ...... , 196.1. ........... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in dupl'i~ate to the Building Inspector. b. Plot plan showing location of lot and of buildings on p remises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property rnust be drawn on the diagram which is port of this application. c. The work covered by {his application may not be commenced before issuance of Building Pe~'r~it. 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 pa rt for any purpose whatever until o 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 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) State whether applicant is owner, lessee, agent,, architect, engineer, general contractor, electrician;~.plumber or builder. Name of owner of premises .....gee:P~'e..~:..~a~'¥...JBJ,~,h.1 ........................................................................ : ......... .................. If applican~t is a corporate, signature (if/duly authorized officer.. (Name and title of corporate officer) "~,. " 1. Location of land on which proposed work will be done. Map No: O~woOd'"P&l'l~ ............... L~t No: .....~) ........ Street and Number ....W/S.....Oekwo.ocl...ljr:tvei.....~.uo~t~j~dy ................................................................... [ ......... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .~'~ecq.tl~ 'J~'J; property lines. Give street and block numbers or description according to deed, and show street names whether interior or corner lot. 3. Nature of work (check which applicable): New Building _~ ....... Addition .................. Alteration .................. Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................ 4. Estimated Cost ...~..~3.~)(~) ..................................... Fee ......... ]'~e"l~'~i~"~)~"fiii'A;'g'i;";'C~;ii;;;;g~;i ................... 5. If dwelling, number of dwelling units ...... Otto ................. Number of dweffing units on each floor ...................... If garage, number of cars ............ ~,~to",.."~t:~;'aO~e~} ........................................................................................ ; ....... .6. If business, commercial or mixed occupancy, specify nature end 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 n~w construction: Front .......... 68 ................. Rear .......... fJ'8 ............. Depth .....].~r .................. Height ......................... :... Number of Stories .......... I:~rlil~ ................ 9. Size of lot: Front ...... '],~)O .................. Rear '"'100 .................. Depth '""~)O ............................ 10. Date of Purchase ............1'~O .................................. Name of Former Owner ...... ~llt~el;t~ ................................. tl. Zone or use district in which premises are situated ....... tt&,t~ ................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? .............. 1~¢1 ................................... 13. Name of Owner of premises ...J}.a.JB~eJ¥]: .................... Addres~ II~r...i.i)rct. e...1~a~,~ ............. Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ..... (}~'~'i'~llt:l;~"&..L~' ........ Address ....... 8.Otlt:~o.~l.~[ .................. Phpne No ..................... PLOT DIAGP, A,M Locate clearly and distinctly all buildings, whether existing oF proposed, and indicate all set-back dimensions from and indicate STATE OF NEW YORK, ) S.S. COUNTY OF '"8%1~'~]:)~ ....... ) ................................... ~..~.....¢tt,~-~, ................................... bein9 'dul,y sworn, deposes and says that he is the applicant (Name of in~Jt~ictb~l ¥¢¢~l~'application) ' above named. He is the ........... ~. ~,.t~;¢.~.~' ........ 0~"~e~'"'~ ................: ....................... ;', .............. : .......................... ..... ~on ractor, 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 afl statements contained in this application are true to the best of his knowledge and belief; and that the work will be perfoj't~¢ j? ~t~j~l~manner set forth ,in' the application filed therewith. Sworn to before me this I't, hl,c. state of Hew York ' -- /2 ............... .,,,, . .... Notary Public, ..,,,~-7,~¢,,~?~...¢~.....~,~.~,r~,z?[i~C¢'¢~'C~dl~ (Signature .............................