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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? 2152 Z
Date ........................... A~'U~'""~9 ...... 1963"-
Permission is hereby granted to:
· ..[1.1e~...l.,...Piht .............................................
............. .~..-~e~t~,..~.~. .....................................
......... ~a.~...W-~.t t.fs.t~m .... ~ ~..I.~. .......................
to · ]~u&ld...r~ew...one ·. £am~ ~.~ ..~.we.l~.£ng .....................................................................................
at premises located at ..~'~.....~'..&..~+6.....~e~.ne~...Bay..¥s¢.~¢~e~.....~.ee.-.~,~ .................
................................ Old...O~t~r~....~n~ ~ ....... ~:~s~c'-'t~i'o~ .....................................................
pursuant to epplicatiou dated ......................... Allgt;LSt ....... ~..~, ............ 19~..., and approved by the
Building Inspector
Fee $.10,00 ..........
s-9
SUFFOLK COUNTY DEFARTP~NT OF HEALTH
Date June 19~ 2,,96)*
Building Permit Noo~
TO V~IOM IT MAY CONCERN:
The sewage disposal facilities for a structure located at
Lots ~t~ & ~[.6~_Oard~_ners Bays Rstates,..Eas$ Marion (P~h~)
· (~¥e 'deed lOCation)
have been inspected by this Department and found to be satisfactory,
Cf'
District Engineer
FO]~VI NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Examined ............ 'l ......... , 1 9....,.. ....
Approved ..................... !.:: ............... , 19....f.!..Permit No. ....
.................. ................................
am~ t p
Application No. c~ / ,~-,L.-~
APPLICATION FOR BUILDING PERMIT
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 lot and of buildings on premises, relationship to adioining premises or public streets or
areas, and giving a detailed description of layout of property must be drawn on thediagram which is part of this application.
c. The work covered by this application may 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 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 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, or name, if a corporation)
........ ...... ....... i(. .................
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises L.L 't'J I tZAbx [ tHC
if applicant is o corporate, signature of duly authorized officer.
(Name and title of corporate officer) ~ I /
1. Location of land on which proposed work will be done. Map No: .... ~.!.7:...~,..../.~.(A..~.,...~i'~)t No: ......... ~/'~ . ......... ~' ~
Street and Number .................................... ~.~.~......~I.A[~.~J..C.g.~ .........................................................................
Municipality
2 State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy (,,I ix[ (/C,~' Cl IL21 Fz ~7]
b. Intended use and occupancy ........... ..~....L.'!..~.~(~f!.~.,!:~.,.,..!ii!~'..b../.t...~., .....................................................................
3. Natbre of work (check which applicable): New Building ..... ~ ...... Addition .................. Alteration
Repgir .................... Removal .................... Demolition .................... Other Work (Describe) ........................
4. Estimated Cost ............. ~.....~..,/..~....~,..O...: ................... Fee
(to be paid on filing this application)
5. If dwelling, number of dwelling units ....... ..~..../~.j~ ............ Number of dwelling units on each floor
If garage, number of cars ................ ~/.z\.[.~.~.L:~,O....~....I ........ ~..~.I~..E.....~,~/..L.I~.)
f. If ~usiness, commercial or mixed occupancy, specify nature ,and extent of each type of use
7. Dim'iensions of existing structures, if any: Front...~.... Rear ...........
HeiCht ............................ Number of Stories
Dimensions of same structure with alterations or additions: Front ................................ Rear
Depth ............................ Height ................................ Number of Stories ........................................
/47' ' ..%.-1
8. Dimensions of entire new construction: Front ................. .~. ............ Rear .......................... Depth .......~.~...~...~..
Heieht ........ Number of Stories .... (~2 N Lz
9. Size¢of lot: Front ...... 1.~.¢.! ............... ~ ~ - ~
· I Rear ...... I" '~'E>' ............. Depth ........ t" "~ ........................
10. Dat~ of Purchase ..... ~.~.LJ.~..:.....~.../.~......(..~l..~2~....Name of Former Owner .................. .c~...~(.~.~..r.~..~. ..........
11. Zone or use district in which premises are situated~..~;../.~...~...~..~!..M...~..C~...~.~.....(~....A...~.~/..~..~.~..%~~...~...~.~.~7..
12. Does proposed construction violate any zoning law, ordinance or regulation?
13. NameofOwnerofpremses~..~..~-..~./~..k,..~-¢..l~/~ Address ~6 r')~'rz~V
.............. E./t ~ .'¢' · ~,~¢ ~./= e 4. ~9 .%.O.~d ...... Phone No.
Nam, e of Architect ..~.~.J..:...~..~./~..c;/.~...C.Z,.&.'Z~ ...... Address (~ ¢~ ~C~i kr S I)rZ~ v ~F Phone No.
Name of Contractor .~.kl.~.E....~.~M.g..~...'~.-J~.~.l~.~,....Address ,~4~U..-F.M.¢'-{.~4..I?.~.~%~/ ......... Phone No.
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fr.
property lihes. Give street and block numbers or description according to deed, and show street names and indic,
whether interior or corner lot.
L oc u¢'T
STATE OF NEW Y~RI~/,/~ ) ( p~,uA~ IZ~D ~T
COUNTY 'OF ~ S.S.
.............. ~...~.,.~ ....................................... being duly sworn, deposes and says that he is the oppJicc
(Name of individual signing application)
obove no~ed. He is the ....... ~ ................................................................................................ ~ .......................
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or hove performed the said work and to make and fib
this application; that all statements contained i~ this application are true to the best of his knowledge and belief
and that the work will be performed in the manner set forth in the application filed therewith. ~ ~ ,
Sworn to bbfor¢ me this .. ~,~te al .~ ~ / /
..................................... .......... , ................