HomeMy WebLinkAbout1506-z FOEM NO. 2
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
?
('~IS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 15o6 Z
Date ....................... ~lj~a.S~.... 1~ ............. 19.6.1...
Permission is hereby granted to:
Par a~an"~ome s'"' ~C'"' 'John" ~'"~'ma" Cons t~.ut/ne
......... ~99'"":T~rieha'TNc ...............................
........ : ...... ~neo'~&' ................................................
to .......... B-u~ id "rm%r ' 'one ' - l's~l~.y' 'd~ '1~ .............................................................................
~t premises located at "Lo~;"#1~'3';""'Cap~"Z~.'~a'"E~t:~e'tl .......................................................
.............................................................. Matt~t~=k .............................................................................
pursuant to application dated ............................ .~....~ .............. 19.6.t.., and approved by the
Building Inspector
Fee $ ..'101{)~ ...........
, · ' ouilding Inspecto/
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Application No ....../...~....0. ~
APPLICATION FOR BUILDING PERMIT
are ................... ~. ................................. 19 ............
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 Jot and of buildings on premises, relationship fo adioining 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 Idspector 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 a Iterations, 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, electrician, plumber or builder.
.................................. ..............................................................................................................
Name of owner of premises ....... u...~...~.~.~....?..~....~...:.L~.~.[~:..~..~..~.~...~./....~./...:.~:~..~.....L...\~...... ..........................................
If applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate officer)
Location of Jandon which proposed work will be done. Mop No: ......... ~ /~. ]~...:f../Lat No: ...........
Street and Number .......................................................................................................................................................
Municipality
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy .......... /~..~.../. ........... /..'.~,.~cl..~2../..,,c~, .........................................................................
'IL/ ........
3. Nature of work (check which applicable): New Building ...... .~. ......... Addition .................... Alteration ....................
Repair .................... Removal .................... Demolition .................... Other Work, (Describe) ....................
4. Estimated Cost ........ ~...?....a...~...'...!. ................................ Fee ..........................................................................................
(to be paid on filing this application)
5. If dwelling, number of dwelling units .........Z .................... Number of dwelling units on each floor ............................
If garage, number of cars .............................................................................................................................................
6. If business, commercial or mixed occupancy, spec i~ 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 ....... ,u~.~t ............ Rear ...... ..~.....~.. ............ Depth ......'~......"~.. ..............
Height ./..~ ......... Number of Stories ....... ; ....................
9. Size of lot:- QFront ...../..~...O. ............. Rear ...... ../..~ ........... Depth ...... ./..~...O..i .........
10. Date of Purchase ......'~..~,~...........~..:......].~..~....¢~.... ...... Name of Former Owner ........................................................
11. Zone or use district in which premises are situated ...................................................... : .........................................
12.
Does proposed construction violate any zoning law, ordinance or regulation? .............. ~ .................................
Name of Owner of premises.,J&:~, .~...~.~16W,..~.~ress, ..~.~.~.....~.~..~..~'l~h.~e NO .....................
Name of Architect......~.~:~...~........ Address ....~.,~...~..:.~.~.~...~hone-r[-PlC NO. ~...~....~..~c.~
Name of Contractor ...............I~. ..................... l.~ ......... 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 KLEW )t'OI~K, - ~ ) S S
~bove named He is the. ........ ~.~...~.'-~ ................................................
· . .... ~l"'"~r~'-~='~'~:~.~tor, agent, co~o~'~ '~f~ic,;, ~.)
of said owner or ownem, and~ duly authorized to perform or h~e peHorm~ the said work and to ma~ a~ file
this application; that all statements c~tain~ in this applicati~ are tree to ~ ~st~ of his ~wl~ge and belief;
and that the work will ~ performed in the ~nner set fo~h in the applicati~ filed the~ith.
Sworn to bef~e ~ this _ . -- . . JUDITH T. ~KEN . ~r ~
~/~ ~,~ /~ NO~i~ ~blic, ~ ~ New Yo~ ~ ~ .
~of .... ~~... 1~;9~449~. Suffolk ~.~ze (S~ture of pppl~)
................. ~.~ ~ n "~"~ .~~.~:. ',~ E~m~r~s March ~, 1~ /J ~ ~ ~ * ~
CAPTAIN KIDD ESTATES
MATTI TUCK INLET
DAWN ESTATE..% IN(:;.