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Home My WebLink About3263-z FORM NO, ~ 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? 3263 Z Permission is hereby granted to: ........... .9..o..t~..Oq...~......~..~....e..t.=....~..:~.:..... ~.c....~.o serb cat. ret .............. ,Ta~s po ~'.t ~ .....1~ ,'~.~ ........................... to ~.d ~.e..v...~l.~.e~.3Jmg ....................... at premises located at ......11~/-q.....O.~;J..~l~e..-~lJ~ ........................................................................... ................................................. Kat~ti~ae~ ~ .....N,.~., ......................................................................... pursuan¢ to application doted ......................... J~ep~,....~l,~. ............... , 19.~(~., and approved by the Building Inspector. JJO~'~l D~re:Lltz~& t,o be &,~ approved by I~oaz'd o£ Appeala Fee ~***0..?, ,0,0. ............ .... ~'~ilding Inspecto[/f 1 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ........................................ , 19 ........ Approved ......~.../.~.. ......... , 19 .~....~..Permit No .... ..~....~.....~.......~........~.. D,sapproved a/c .~.~..~...~'~.~ ..... ~ ....... ._. ........... .... ................................. ................................. APPLICATION FOR BUILDING PERMIT Date .... ~,'~1~...%,~ .........................., 19.66 ..... INSTRUCTIONS a Th~s application must be completely filled in by typewriter or in ink and submitted in duplicate to the Buildin~ Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adioining premises or public streets o areas, and gwmg a detailed description of layout of propertymust be drawn on the dmgram which is part of this apphcat~on c The work covered by this apphcat~on may not be commenced before ~ssuance of Building Permit. d. Upon approval of th~s application, the Budding Inspector wdl issue a Budding Permit to the applicant. Suci permit shall be kept on the premises available for inspection throughout the progress of the work. e. No budding shall be occupied or used in whole or ~n pa rt For any purpose whatever untd a Certificate of Occupanc' shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Budding Department for the ~ssuance of o Budding Permit pursuant to th Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o Regulations, for the construction of buildings, addihons or alterations, or for removal or demolition, as herein described The apphcant agrees to comply w~th all apphcable laws, ordinances, building code and regulations. (Signature of applicant, or name, ~f a corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ....................................... ~:~;Lueer... ~or... t:)m~ r. ............................................................................................................. Name of owner of premises ...... J~e~h~`~..~c~aha~`e`t`~`~..~.Mai~.~`q~e~t.t~.~?i.~:~ez~h.~`~ ............ 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' . ...........................................Lot No: ................... Street and Number .......... g. le...,]'ula..Lana~..Ma.t,~l:b~tck~..}J,...~r.~ ................................................................. Munic,pahty State exist,ng use and occupancy of prem,ses and intended use and occupancy of proposed construction: a Ex,sting use and occupancy ............ .V.~azz~..LgJ~ ........................................................................................... b Intended use and occupancy .......... .~D~1.~D'~~/i~.~t~:~~(~g.~.~.~~ ......... & ,~on ,~ 3. ~ Nature of work (check which icone). New Budding .... .~ ............................. Alteration ................. Repair .................... Removal .................... Demohtion .................... Other Work (Describe) .................................... 4 Estimated Cost ........~0.~4)(~ ................................... Fee (to be pa~d on filing th~s apphcation) 5. If dwelling, number of dwelling units ...... ~ ............... Number of dwelling un,ts on each floor ..... c~/O .............. If garage, number of cars ..............-T~_t~,,,~-"~ ............................................................................ .......... · ...... · -. ... .., ...... · · 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .............................. 7. Dimensions of existing structures, ~f any: Front .......................... Rear .......................... Depth .......................... Height .......................... Number of Stories ............................................................................................................. D~mens~ons of same structure with alterations or additions: Front ................................ Rear .............................. Depth .............................. Height .............................. Number of Stones 8. Dimensions of entire new construction: Front ...80...~.~ ........... Rear .......... f~"~'t,'i ....Depth Height .A~,,...:l~.~umber of Stones ...... 1 ................... 9. S~ze of lot. Front ...]~F~...£I$.#. ........ Rear ""];~rO"'~t'& ........Depth ......~]:(}..£.~¥ 10. Date of Purchase ...,,~I~t;;,,...1R,~...1.9~ ................... Nome of Former Owner -~¢'~...Va.~..'~s~¢~ ................... 11 Zone or use d~str,ct ~n which premises ore s~tuoted ..... ~,~.~na~t...A ............................................................... 12 Does proposed construction violate any zomng Iow, ordinance or regulationP '"'~'1~ ......................................... 13. Name of Owner of premises ..,T.~...l%~....~.I~ ....... Address .~O..~.~..{,,~.~i...];~¢~.,~.. Phone No.p~...,~,,~,~r~ Nome of ~ ....... (~.,,](~,A~8,l~...~t.,...]3, ....... Address~(a~r~..~t~t~i...gyaS~tt.~.. Phone No.J&...i~,,,~L:~ Name of Contractor .................................................... Address ............................................ Phone No .................. PLOT DIAGRAM Locate clearly and d~stinctly all buildings, whether ex~stmg or proposed, and indicate all set-back dimensions fro property hnes. G,ve street and block numbers or description according to deed, and show street names and ,nd~co whether interior or corner lot. STATE OF NEW YORK, '( ¢ S COUNTy, Of ~f£olk ............ / ~' ... : ............ being duly sworn, deposes and says that he is the appli~ " (Name of ind~vidua sign,ng app ic'otion) above named. He is the ............ E;n~;~-~...ftc~.~..~'er~e~, ............................................................................................ (Contractor, agent, corporate officer, etc.) of so~d owner or owners, and is duly authorized to perform or have performed the said work and to make and th~s applicahon, that all statements contained m this application ore true to the best of his knowledge and be and that the work w,ll be performed in the manner set forth m the apphcation filed therewith. Sworn to before me this ..... do, of , ....................... /Z-..' ..... .......... ............... Notary Publ,c, ...~/..~..~.:~~.w..~..°r~ount};... ........ (Signature of app cant)