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Home My WebLink About3570-z^ppmved '~ 19....t.t.. Permit No. ~"~ ~' 7 0 ~ ~,~(~1 5 ~ *PPLICATION FOR BUILDING PERM o ......................... ....... ...... . INSTRUCTIONS a. Thi,~ opplicatio~ must b~ completely filled in blt B~:~writer or in ink ond ~ubmitted in dupli¢~e to the Building In~:~r. b. lot plan showin.~ Iocofio~. o.{ I~ ~ of buildl~ ~ p~mi~, ml~ti~hip ta ;~ :~ ~,~e of ~ T~ ~ ~d, Suf~lk C~n~, ~ York, e~ ~r ~1~ u ~, tot me c~st~ ~ ou,a~ ~ltl~s or al~emh~s, or for ~al or ~molifi~, m ~n ~ri~. app.cant ~s to c~ply ~th all ~phcoble I~, ord~,, ~lldi~ c~ ~ ~ulatl~s. .~ Helmut Hass (Signature of applicant, or name, if a corporation) North Road Southold (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. owner - builder Name of owner of premises ......H..e....l~...u...t.....H..a...s..s. ................................................................................................................... If applicant is a corporate, signature of duly authorized officer (Nome and title of corporate officer) !. Location of land on which proposed work will be done. Map No.: ......~.$.s..s.~ ......................... Lot No.: ...~ ..... StreM and Number . .$./.~..~..V..T..t ..R...0 .W (Beverly RoadO Southold. N.Y. MuniciPality 2. State existing use and occuPancy of premises and intended use and occuPancy of praposed construction: a. Existing use and occuPancy vacant lot b. Intended use and occupancy ...... ~'~L.y~.~.q...g~r.~.~....&.....8..~..o.~.~g.q ' . ..................... ........................ 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair ........ ,~.....-~ Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ....2, a.0,.O..O....?..~.. ................................... Fee ~'.00 (to be paid on filing this application) 5, If dwelling, number of dwelling units ....~..o?.e. ................ Number of dwelling units on each floor ............................ If garage, number of cars. tE.o. & storage ~ 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 some structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ...2..0. ............................ Rear .... .2.0 LF0 ....................... Depth ........................ Height .................... Number of Stories two (Max heigth 18ft 9. Size of lot: Front ...~....~. ................. Rear ...... .~..~. ......................... Depth .....,1.2.?....+.. ............... 10. Date of Purchase ....................................................... Nome of Former Owner ........................................................ 11. Zone or use district in which premises are situated ~B" dist 12. Does proposed construction violate any zoning law, ordinance or regulation? ................... D,~ .................................... 13. Name of Owner of premises ....~.~..~[~.~.~ ................... Address...................,S°uth°ld........................ Phone No ..................... Name of Architect ...................................................... Address ........................................... Phone No ..................... same Name of Contractor .................................................... 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 number or description according to deed, and show street nc mas and indicate whether interior or comer lot. STATE OF NEW Y~Rl~,e,,~t- tee COUNTY OF ....... .~ ..~...t. ~...'~'.. ........ ,f '~"~' ?5. Helmut Hass ................................................................................................ being duly gwohn, deposes and says that he is the applicant' (Name of individual signing application) above named, He is the ......... Omlle. r...~....l:tlli'lclaz'. ........................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to rn~ke 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 set forth in the application .filed therewith. Swomtobeforemethis ~ /] t / ~ -~ // , . . . 1~ A st 67 ' . ........... : ......... day of ..... ................ ........... :' ........ Nota P~ ~ /'r~, _ ~ ~ .,.~I..~.~../F~'.~ ......... .'.~.,~C...~'.. ...................... ry ublic~ .L.~.....~.:...I..~.. County (Signature of ap~l|c~nt) ~ '~ [I ~ARI§N A. REGENT ~ ~ NOTARY PUBLIC, State of New York No. 52-3233~20 Suffolk County. Term Expires f~arch 30, FORM NO. 2 TOWN OF $OUTHOLD 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? 3570 Z Permission is hereby granted to: ............................... :.??. ....................................... ................... .~.,m..~t~b~.~,,.~ ......................................... to . .~.u. ~...a~.~.. ~.~e..~... ;~.~.~;~:~gc, ..:~r~.~:&~ ................................................ : .................. at p,em~es ~ocate~ ot ....~:..~..~:...~.~.~....`:?:~.`.':~..~.~?.".~.~..~..::r.`~...~.`.~....~.~.~": ................................ ..: ............................................ ~.~.U.t~,., ~.~%1~. ............................... ,'..,...~ ........... , ........ -...~ ................ pursuan,t to application dated ................................. ~?~'~.~.~. .......... ,~ ]9....:.~.? ~nd' approved by the Building Inspector. -: '. Fee $ ....................... ..... "'~"T" .........;"~:' ':'" ....... ~' ' ' ........ Building Inspector ~ ~' FORM 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? 5615 Z Permission is hereby granted to: ............. ~.~a~ ................. ,.....:...: ........... .................. ~,~. ...... ~.~,, ............................ pur~Uan¢ to application dated .............................. '~::"~r~'.""":""o 19'L~:~ and approved b~ the Building Inspector. ,., ,