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Home My WebLink About4990-z " ' ', /, //0 0/~,~. ~ Permit No. App~wed ........................................ ,19 ........... .'J:../...Z.~.. ........ / , , L~l ~ o/c .............................................................................................. / \ API~LICATION FOR IUll.~tl~ I~L~n' ~)~ Date Octobe~ 6 19...~.0. ..... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink und submitted in Impaotor. b. Plot plan showing location of lot and of ' , bu_ildmgl an premises, relationship tO Qdjeini.~:pmmlei8 ar~ areal, and giving a detailed oe~criptlan of layout ~f pre~m~y mu~t be drawn an the diagram ~ c. The w~k covered by this el:~JlcatJon may not be commenced before i~ of B~ikli~ d., Uijoon. app.r?al of .this april .ca. tlog, the Bul.ldlr~. Impector .will Imue a Building Permit tothe ~lqllllemt. ~aeh permtt:~. shall oe Kept on me prom:sos avaflame for inspection mroughout the pragree* of the work. e. No building shall be occupied or used In whole or in part for any purpaee whatever until a Clrtlfk=ete of Ooc~ar~y - shall have been granted by the Building Impactor. - B .A. ,P. PLI_CATI _ON !S HEREB, Y.MA_DE to the Building Del:mrtment for the i~uance of a Butldl~ Permit ~ to the u ..,nonc..or ? ,? ..So tho , S olk C.o n , Y?, and ~eg m ..om..tar me consrrucrl.on or DUllalr~: a~dltlonl or alterations, or ?r removal ~r dlmellt~. ~1 ~ dllcrlbed. ~ ne app.cam agrees to comply wtth all ap~hcable laws. ordinances, bulld,ng code, hou~lng code. and C,~gflorure c? aF~llcaflt;or name, If a eeql~lltofl) ............ 3.onnd...~lew..a~a(L ...... ~=%ent ........................... (Addmm of amaltcent) State whether applicant is owner, Imee, agent, architect, engineer, general contractor, electrician, ~ or bulldlr. ....................................... ~o~.~.~to~ ................................................................................................................................ Name of owner of premise~ Eclw&:rd & Eleanor® Com:Lske~y If applicant is a corporate, signature of duly authorized officer. (Name and title 'of corporate officer) 1. Location of land on which propoeed work will be done. Map No.: ....Q~,1,fl~..~...~. ..... Lnt N~.: ...... .~.~ ............. S~eet and Number ........ ..~.~..~........~..o...~.~...~...e..~.....D.?...~..?.?. ......... ,O...~,~..e.~...t. ..................................................................... 2. State existing use and occupancy of premises and intended use and occupancy of pmgamd e~mfmctlan: a. Existing use and occupancy ....... .T.~I,I~a:L~ .............................................................................. ... .. b. Intended use and occupan:., . .................. ~]~a..fai~L3,7:..cLwe~,l,t~ ................................................................ 3. Nature of wo~k (check which applicable): New Building .... ;~ ...... Addition ................. Alteration ............. Repair .................. Removal ..................Demolition .................. Other Work (Describe) ..................................... 4. Estimated Cost .........~.O.~.O00...-h ............................... Fee ....1.0.~.(~) ...................................................................... (to be paid on fi~ing, this application) 5. If dwelling, number of dwelling units ...CIZ~e. .................. Number of dwelling units,.on each floor ....................... If garage, number of cars ........ elze ............................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing s~ructures, 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 ........ ~2 ........................ Rear ........... ~2 ............. Depth -.--30 .............. Height .................... Number of Stories ...... OM ......................................................................................................... 9. Size of lot: Front ....... .1.¢~ .............. Rear ........ .1.57 ..................... Depth ....:$)~.~.../....1.~6 ...... 10. Date of Purchase ...........1.¢)~8 .................................... Name of Former Owner ........ 0'~3. ........................................ 11. Zone or use district in which premises are situated ..... .".~k?...l~,l~.l~ ............................................................................. 12. Does proposed construction viol~.te any zoning law, ordinance or regulation? ........... ~ ........................................... ]3. Name of Ow~.er of premises .~..&..~..C~lll;L~]r,e~.....Address ...... .0.?..~.e...~..~. ........................ Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ...... ~g~g~...i~,.o.~.t~ ................. Address ........ D:~,l,ei31; ..................... Phone No .................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from properh/ lines. Give street and block number or description according to deed, and show street names and indicai'e whether interior or corner lot. STATE OF NEW YORK, t cc COUNTY O F ,. ~a.f'.~e~ ir....; ....... ............................................ ~.{l~.~3~.t;...~D31.l.~' ........... ,.....being duly sworn, d~s and says t~t he is the applicant (Name of individual signing application) a~ve named. He is the ....................................... Cea~ ................................ ~' ....................................................... (Contractor, ag~t, co~orate officer, ~.) of said ~r or owners, and is duly authorized to perform or h~e perfo~ed the said work and to ~ke ~d file this aPPlication; that all statements contained in this application are true to ~e ~st of his knowl~ge a~ belief; and that ~e work will ~ performed in the manner ~t fo~h in the a~[cati~ filed t~i~. S~m '~ ~re ~ ~is ~ ~ ~. ~ ................. o, .......... ........... , ..... ......... ............................. ~. 52~Z25850, Suffolk Te~m ~Fir~ M~ch ~, l~ FOlllli NO. ~ TOWN OF SOUTHOLD ~ BUILDING DEPARTMENT TOWN CLERK'S oFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ~N THE PREMIS,ES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 4990 Z Permission is hereby granted to: at premises located at ................... ,~;"~6'""O"l*i~[it,"~r'~"t~ll[ ............................................. ............................................. t~/li, · .l~m,t;.~ · · ~.c.-~' -'~ ~ ......... ~eat' '"~,~ ............................... PUrsuaa¢ to application dated .......................... ID~.t; .......... 6..;...-..,.,.-, 19...~[~0-, and approved by the Building Inspector. Fee $....ill,.~ ......... .............. (~.~...( ................. ~ , ~, Buildinglnspector [ FORM TOWN OF soUTHOLD i BUILDING DEPARTMi~N~r TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 19 ........ Permit No ...... Disapproved a/c .............................................................................................. (Buddt APPLICATION FOR BUILDING PERMIT Date acta'bar ~ 19..70 INSTRUCTIONS a. This application must be completely filled in by typewriter or in!ink und submitted in duplicate to the Building Inspector. ~ b. Plot plan showing location of lot and of buildings on premises, [el~tionsh~p to adjoimng premises or public streets or areas, and giving a detailed description of layout of property must be drawq; an the diagram which is part of this application. c. The work covered by this application may not be commenced befdre issuance of Building Permit. d. Upon approval of this application the Building Inspector will issule a Building Permit to the applicant. Such permit she 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 r~urpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New !York, end other applicable Lows Ordinances or Regulations for the construction of buildings, additions or al!orations, or f?r removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordmonces, buildH~g code, housing code, and regulations. (Signa~re cFo~p~STico'h'f,~or name, if a corporation) ............ ~.ou~d...~.~w.. ~,o~d ....... .C~£e~t ........................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, geneFal contractor, electrician, plumber or builder. ....................................... Con.tr.a .to ..................................................... ', ................. .......................................................... Name of owner of premises ..~...c];.?[.~..~.~;..~....~.~.e..~..9.~.....0..O.~. :~.~.e.~. ................................................................................... if applicant is a corporate, signature of duly authorized officer. (Name and title 'of corporate officer) I. Location of land on which proposed work will be done. Map No,: ..;.0.~,~,~'L~.~'...~.P,.~ ..... Lot No.: ...... .~.~ ............. Street and Number ........ .~/.~.~.....]~.O..~.~);..~.fe.,a.....D..r..~..v..e.. ......... .O,,.~,~..e..~.~. ......... ~ .......................................................... Municipality 2. State existing use agd occupancy of premises and intended use a~d occupancy of proposed construction: a. Existing use and occupancy ....... .~.~.C~,~.~. ................................ i ............................................................................ b. Intended use and occur:an::, . .................. 4DT~..~'~.~...~.~...(~i.]~.~.~.T~. ............................................................... 3. Nature of walk (check which applicable): New Budding .... ~ ...... Addition ................ Alterahor~ ............. Repair ................. Removal ................. Demolit~ar~ ..................Oti~er Work (Dcscribe) ................................ 4. Estimated Cost .......... 20~.000..-I- ..............................Fee ....1.0.~.00 ....................... , ............................................ (to be paid on fi.lng this application) 5. iF dwelling, number al' dwelling units ..Grt.O .................. Number of dwelling units on each floor .................... If garage, number of cars ........ o~e ............................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: F~on~ ........................... Rear ............................... Depth ........ Height ....................... Number o~ Stories ........................................................................................... Dimensions of same structure with alterei'ions or additions: Front .................................... Rear ......................... Deplh ................................H.=ight .......................... Number of Stories ................................ 8. Dimensions of entire new construction: Front ........ .~. ....................... Rear ...........~2. ............ Depth ..... ~ .............. Height .................... Number of Stories ...... O~z~ ........................................................................................................ 9. Size of lot: Front ....... .1.06 .............Rear ........ .1.~.2. .................. Depth .....1~.~.../...~)+~ ...... 10. Date of Purchase ........... ~.C)~8 .................................... Name of Former Owner ........ ~.~.1. ....................................... 11. Zone or use district in which premises are situated ..... !!/L!!...cl;:L.s'b ............................................................................ 12. Does proposed construct;on ~iolate any zoning law, ordinance or regulation? ............ 1~) ........................................... 13. Name of Owner of premises ..~..~..J]..G.o~,1.$.~e~,....Address ...... .0.~i.~Jk~ ....................... Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No .................... Name of Contractor ...... .~b~..C.oil, llt%~ ................ Address ......... O.~'..'].e.~,~; ..................... 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 names and indicaYe ~¢hether interior or corner lot. STATE OF NEW YORK, I.S: COUNTY OF .... {DQ~"90'];k ........... J' "~' ............................................. R~.be,lc.~...C:olit;;L.~]~e.~ ................ being duly sworn, deposes and says that he is the applicant Name of individual signing application] abow., n~med. He is the ....................................... ,g~m~,'z-e.¢'b'o~' ......................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that mil 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. // Sworn to before me this l/ /) ~ /1 /') ' IJ .................. day of .......... ................. , -- NOte r', PubJic,~ ~ .~..~..... Cou,~tv~/~' ' "' 'v'~ ' ' '~' -'T' ( S ig ~r e ~f' "~j~; [~'~ n t ) ................................................................ ~IOTARY PUBLIC. State of N w No. 52.8125;~50, Suffolk CouJ~ty~, ,Term Expi~ M~rch 30, ]9~,~ :1 / i ,I