The URL can be used to link to this page

Home My WebLink About3676-z FOl~l NO. ~ TOWN OF SOUTHOLD BUILDING DEFARTbAENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 3676' Z Permission is hereby granted to:, .... ........... ,i~.~.. ~.~.~'.~, ..................................... at premises located at ..~J~..~JlJ..~....a~.~l~ .................. ~ ........................................................ ............... .~ .............................. ~,t~kt...~.,.~, ............ : ................................................................. pursHan~'ljo 0pplication dated ................................ ..~....~. ....... -,~,,. ........ , 19.r.~-.~..., and approved by the Building, Inspector. Building Inspector FOI~M ~0. 1 Examined ........................................ , 19 ........ TOWN OF SOUTHOLD BUILDING DEPARTMENT SOUTHOID, N. Y. Approved ........................................ , 19 ........ Permit No ............................. [Disapproved ak .........:.,..,~: ......................... ~.~ ........... ...~.~.~-a :~ ......... ........................................................................... ~: :.,f .:.~.~.~. ~:~.~x..-~: ::. .................................. ...... r ......................... SIGN APPLICATION FOR B'~ PERMIT # 270 ~,) I~ / Application No ..................... : ....... 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 adjoining premises or public streets or areas, and giving a detailed d~scrip~ion of layout of propeFty must be drawn on the diagram which is part of this application. c. The work covered by this application may not be ~=ommenced before issuence 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 inspecti9n throughout the progress of the work. e. No building shall be dccupled or used in ~+iole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspe,c, tor. 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, Sou~hold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the constructi6n of building¢, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code and regulations. Bt~. ze Cta, ke (Signature of applicant, or name, if a corporation) ..... !. ................................................. (Address of applicant) State whether applicant is owner, lessee, agent, archi,tact, engineer, general contractor, electrician, plumber or builder. Name of owner of premises l~,l!~i ' ~Oi~k?.;.I . If applicant is a corporate, signature of duly authorized officer. (Name and title of cq/porate officer) / '" XXX Lot 1. Location of land on which' proposed work will be done., Map No.: No.: M he :afro i~oad a Bay five Stere existb9 use ~nd occupancy of premises amd infen~ed use amd occupancy of proposed construction: t~sin, oss sa~o with gro~a ~ s~gn b. b~ended use ~d occupancy .......................................... ~ ........................................ ~ ............................................ NatUre of work (check which applicable): New Building .................. Addition .................. Alteration Repair .................. Removal .................. Demolition .................. O~her Work (Describe) ..... .L'~:I~.'LZI~,..~.:i.~A1, .... EstirJnated Cost ............................................................ Fee ..~10¢...S~..£.~. ..................... (to be paid on filing this application) If d[we[ling, number of dwelling units ............................ Number oF dwelling units on each floor If g,brage, number of cars If ~usiness, commercial or mixed occupancy, specify nature and extent of each type of use ..... Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth Height ........................ Number of Stories Dirrjensions of same structure with alterations or additions: Front .................................... Rear De~th ................................ Height ............................ Number of Stories ................................ Dirrjensions oF entire new construction: Front .................................... Rear ............................ Depth Height .................... Number of Stories Siz~ of lot: Front ............................ Rear .................................... Depth ................................ Da~ of Purchase ................... ~..~.~. ........................... Name of Former Owner Zo~ or use district in which premises are situated ...... ?.~?!...C~.','L~. .................................. Do~ proposed construction violate any zoning law, ordinance or regulmion? ...... Kl, O .... Naa.ne of Owner of premises .]J.~l~&~...gl~ ........ Address ...~J~.'~..~",~.:J~O3~ ............... Phone No. Narhe of Architect ...................................................... Address ............................................ Phone No. Nal ne of Contractor ............. ~.../~....~. ............................. Address ............................................ Phone No. 13. Local property I whether in PLOT DIAGRAM clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions nes. Give street and block number or description according to deed, and show street names and ~erior or corner STAT'E OF[ NEW Y..OR~,. 1,~_ couNw|o ...... ......... ................ ~ ...................................... , ......................................... being duly sworn, deposes and soys that he is the opplk i(Name of individual signing opplieation) above na~ed. He is the ................... j (Contractor, agent, corporate officer, etc.) of said o~,ner or owners, and is duly !authorized to perform or have performed the said work .and to make and this appliCation; that all statements',contained in this application are true to the best of his knowledge and belief; that the ~ork will be performed in th~. manner set forth in the application filed therewith. . Swam to Hefore me this " Notary Public/ 1': FOR,, ~WN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ........................................ , 19 ........ Approved ........................................ , 19 ........ Permit No ............................. Disapproved a/c .............................................................................................. Application No ............................. (Building Inspector) APPLICATION FOR BUILDING PBRMIT Date ....~.~.T..~..~l..f~.~..-~. .......... J.I ............ , 19.6.7 ..... INSTRUCTIONS o. 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 adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drown on the diagram 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 port 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 a app icable taws, ordinances, building code and ragu arians. · (~lgno Ute o' opplicont,~r'~ne, 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 ....(~).-...g..~. ~.L..~.L9~.~....L.~...~.~...~.~.g~.~.`~s~.b.-~.L:..~...~.* .................................................................. If applicant is o 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 ...~...P~.....:'. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .'....~.h...9.~.c.~ .~.i.~....~-. .................................................................................................. b. Intended use and occupancy ...~.~..~.-~..~..q.~.~-~'.~..:.-..c~....cr.~.~..m...t .... .g~....,H..CL..'..~...e..~ ...................................... 3. Nat~ure of work (check which applicable): New Building .................. Addition ......'~... ........ Alteration Repair/ ..,..~.. ........... Removal .................. Demolition .................. Other Work (Describe) 4. Estimated Cost ............................................................ Fee ~ (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ................ If=l-glaroge' number of cars '....-~.. 6. If ~usiness, 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 same structure with alterations or additions: Front .................................... Rear De~th ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth Height .................... Number of Stories .......................................................................................... 9. Siz~of lot: Front ............................ Rear .................................... Depth ................................ 11. Zone or use district in which premises are situated 12. Do~s proposed construction violate any zoning law, ordinance or regulation? ...... ~ ..................................................... Address ............................................ Phone No. Locat~ clearly and distinctly all buildings, whether existing or proposed, and indicate oll set-back dimensions property I nes. Give street and block number or description according to deed, and show street names and whether in}erior or corner lot. STATE O~ NEW YORK, ~ c c COUNTY I OF ................................ ~ ~'~' ................................................................................................ being duly sworn, deposes and soys thot~e is the oppik (Nome of individual signing application) above nor~ed.~e is the (Contractor, agent, corporate officer, etc.) ~f s~','~r ~ .... q~s. and is duly authorized to perform or hove performed the said work and to moke and this appli~:orion; that oil stotements contoined in this application are true to the best of h~knowledge and belief; that the ~ ~rk will be performed in Che manner set fo~h in the application filed therewith. Sworn to ~ elate me this ................ . ........ day of ............................................ , 19 Notary P~ ~lic, . ........................................................... County (Signature of applicant)