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HomeMy WebLinkAbout5120-zTOWN OF $oUTHOLD ~UILDING DEPARTMENT TOWN CLERK'S OFFICE S~THOLD, N. Y. Approved ........................................ , 19..'..!... Permit No.~..Z....~....~.....~.. ~l~.~ ~'" APPLICATION FOR BUILDING PERMIT ~ Date ................... ~T~rLe ................................ , 19....?~ .... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted irt duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is p~rt of this application. c. The work covered by this application may not be commenced b,'fore issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the progress of the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of o Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinonces,/l~uildin$ code, hou~Tn~gcode, grid regulations. / I ~ /7 .~/ /-/ // ........ .......: ........................ (Signature Cf applicant, or name, if a corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Contractor & B~lcle~' ......... Name of owner of premises ........... ~.~,~...~,...~.1~'~,~ ................................................................................................. .~ 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. r~'m?tJ~.: Eaat...side...of..J)aep ~: Ho].e..D~.~.~.. ,~-/~ Street and Number about 7,65' South of New Suffolk Ave, Aonrox. 1~8 'by 1~2I /-/~ ~ 0 Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ............ ~.I~..r0~'...~.I,!Z~L],C~. ............................. b. Intended use and occupan::, . ......... ~.~.?m...e.~...~&~...~.g.?. .................... 3. Nature of work (check which applicable): New Building .................. Addition ......X ......... Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ...... ~,~,.O0. ....................................... Fee ....... ~.~.(~} ....................................................................... (to be paid on fi!lng this application) 5. If dweIHng, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, number of cars ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ........ , ................... 7. Dimensions of existing structures, if any: Front ...... 3.?.~.6 ............ Rear ........ ~,~, .............. Depth ..,3.~.A3.~..~:~r Height ..'1 ..,S.~O~'.~'. .... Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ........... ~?..,.6 ............... Rear .......... ~?..,.~ ........ Depth .......~.~.~-.~....~.~.~'. .... Height .],..%..~.9.[~'. .......... Number of Stories ................................ 8. Dimensions of entire new construction: Front ......... ~.~.,~6 .................. Rear ....~.,.2 .............. Depth ...... Height ..~....~.~.O.~.~'.. Number of Stories ...~.Q.9.0,...~fLq~...-...~3,q..."Z.~O,~. ..................................................................... 9. Size of lot: Front ........ ,~.~ ..... Rear ......... ],6~.,~.0 ............ Depth .......... 1.1}~.~0.9. ....... 10. Date of Parchase ......... .~.~:~.~-...~).?...0. ...................... Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ........ ~1'~ .............................................. 13. Name of Owner of premises.,,1:tJ~,/k~..~^..~t~.~Address .:~u~.Q..~.~.W'~.~r.~.~.,.~'.,.C[,... Phone No ..................... Name of Architect ...................................................... ~,,~,~__ ....................................... Phone No. Name of Contractor ....D.~l,.~J,,~.~.....~.~ Se[n4n~e,;;i,~f,~;L...A/.:ress ...~'~'~.~..~f].,,~ .......... Phone No....?..~..P,,0.br.9 1' PLOT DIAGRAM Locate clearly ond distinol~_ oil buildings whether existing or proposed, and ind cate a I set-back d mens OhS from propert3/ lines. Give street ar~ black__cc~ ~s~l~_i~F, zqr~nlg4/~ deed, and show street names and indicme whether interior or corner lot./~ ~Hv~;~'~.3, r~ N STATE OF NEW YORK t-- COUNTY OF ............ F""' ........ '. .......... ])&~.¢L~..~o...~,~3.-'~.$C].G~' ........ ]...-~'-..4~ ...... ,.....being duly sworn, deposes and says that he is the applicant ~ (Name of indiyidual signing application) ,.-.e LE~1 above named. He is the ..................... .~.Qi0.~.~.~'...~..]~$].~.e.~ .......................... . ........................................................ (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 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 appJi~tion filed therew,~th. Swom to before me this / / , ii) // /9 ...... ............ ............' .,' ,. ,..~' ./.. /~'., - · ..................... ._,,,~.~..w.~,;.: ............. : ..................................... motor'74~l~c, · .............. ,j....~c.~.....E51~t~.O,TL~ .......... County _ (Signature of applicant) l~3ta~ ~lbJlc. State of Hew York fl"~ Residinl[ in Suffolk County ~ . / ,~nm?t~n F~mres ~tarC~l , FO]R~ 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? 5120 Z Permission is hereby granted to: D~.v~L..S chmie[Le r..... A/C...Phili~....Ber~an .......... ~.u~k~k~e..~o~d ....................................... ................. ~.Q~...~.~.Ch ......... ~.J.., ................. to Build an addition on exis%ing dwelling (Large deck) ~ B at premises located at ........... ~/.~q...~,.~.~.n..l~Ol~..D~ ....... .-... ~.~,~.~....:~.~h ................................... I~ttituck N.Y, pursuan¢ to application dated ................................. J.a~ ....... .J.~ ....... , 19...~..1., and approved by the Building Inspector. Fee $.~.,.Q~ .............. I~OWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ...~.,...;...~,..~ ................. , 19../...!. Approved ........................................ , 19 ........ Permit No. ~.)./..:~....).....~..... Application No ........................... Disapproved a/c ~-,- ~ ~ ~ / .......... · ~.U .~ ..~:..~ ......................... ~?; .............................. (Building Insp'ector) APPLIGATION FOR BUILDING PERMIt' Date ..................... .~.~.D. ........................... , 19 .... ~.~ INSTRUCTIONS a This application must be completely filled in by typewriter or in ink und submitted m duplicate to Ihe Bu,ldin~ Inspector. b. Plot plan showing location of lot and of buddings on premises, relationship to adjoining premises or public streets o areas, and g~ving a detailed description of layout of property must be drawn en the diagram which ~s part of this application c The work covered by th~s application may nat be commenced b~fore ~ssuance of Building Permit d. Upon approval of th~s application, the Building Inspector will issue a Budding Permit to the applicant. Such perm~ 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 Jn part for any purpose whatever untda Cerhf,cate of Occupano shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the ~ssuance of a Building Permit pursuant to th, Building Zone Ordinance of the Town of Southold, Suffolk County, New Yo,k, and other applicable Lows, Ordinances o 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, ordinonces,,~ldn~g c. od,~housj~gg c, pde, add regulations .... ........ to V ' .... . " o, Tuckahoe !,oadt Sound .2each. N. Y. ......................... ........ ..... 11789' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or budder .................... ................................................................................ Name of owner of premises .............. .P..h...~..1.~i~....~....B. 9..Z~...~.~.. ........................................................................ 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 ~. '-.-.-%$.~.. ~,l~9..Q,~.....D..~.~]Do~...~{o..1..e.....D~,.~.. ~g~'/~ about 76~' South of New Suffolk Ave. Approx. 1~+8 by 1~+2' Street and Number ................................................................................................................................................ Municipality 2. State exmting use and occupancy of premises and intended use and occupancy of praposecl construction' a. Existing use and occupancy .................. ..'~...~.....~...~...~.~..~.......~?..?.~.~.../~...~.. .............................................................. b. Intended use and occupan:, . .............. .."~..'..~.c~....~...~..'?......~...::..~.~..~../f~.c.~ ............................................................... 3 Nature of woik (check whici~ applicable)' New Budding .................. Add~tion ......~, ........ Alteration ................ Repair .................. Removal .................. Demolition .................. Other Work (Describe) .................................... 4 Estimated Cost ...... ~.~ ~.(~. ....................................... Fee ....... .~. ~.~.(~. ................................................................ (to be pa~d on fi'rog this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, number of cars ............................................................................................................................................. 6. If business, comrnerc~al or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of e~:ist~ng structures, if any: Front ......~...~.~. ............ Rear ........ ~...,.~. .............. Depth .....~..~.~-~...~:~' Height ....~.....s.~g.~'.7. .... Number of Stories ................................................................................................................. Dimensions of same structure with alter(:tions or additions: Front ........... '~.~. .............. Rear ........... ;~.=~. ....... Depth ......~..8.~.,~....~..~.~ .... He.ght .~....S.~.9.~. .......... Number of Stories ............................... 8 Dimensions of enhre new construchon: Front ......... ,~.~. ................. Rear ..... 2~.~, ............. Depth ...... ~;.~,~..~.. Height ...]......S..~..O,~..~. Number of Stories ....w..o...O~.,....~..e...~.~.....-....~.q..~..o.g~. ............................................................. 9. Size of lot: Front ........ .~.~..~.3-..~. ..... Rear ......... .~.~...0.,.?,0. ........... Depth .......... ],.~.~,,~.0.~ ....... 10 Date of Purchase ......... f.,.~.~.~....],.~...0.. ...................... Name of Former Owner ........................................................ 1 I. Zone or use district in which premises are situated .................................................................................................... 12 Does proposed construction violate any zoning law, ordinance or regulation? ........ ~D .............................................. 13. Name of Owner of premises .~}..3.$..~.~...~.~....~..0.~.D~T~.Address ...~,~.0...~.]I~.8~.~[].,.~.~.~.~... Phone No ..................... Name of Architect ........... Jk/~.~Z....,~%~,Jf;;.l~l(.....,~,5~r?~s ~v~z A/ Name of Contractor ...~..~...~..$..~.]...{~.?....::.C.~..1~...q.~.~.~.. ..... AckJressLJ....~.. ~.~¢.~b.~.O...[,~.~.o .......... Phone No?...~.~. ~I PLOT DI,~G~ Locate clearly and distinct~ all buildings, whether existing or proposed, and ind.cate all set-back dimensions fron property lines. Give street ar~ block humbler or description according to deed, and show street namesland indicat-- whether [nterior or comer lot ~F ~ ~ ,,,- _ t STATE OF NEW~,'~{;~I~,~,, ! ~ ~ COUNTY OF ..~..u~..~.~..~..~.. ............ ,f,~.,~. "'*~ 4,7. .................. · .~l~lE;~.~..~,~,..~.g~3,;.~.{~ ................................... being duly sworn, deposes and says that he is the applicon (Name of individual signing applicati~) ,5 Z,~ above nomad. He is the ..................... .C...O..~...~.,~..~..~...O~.. ............... c~;' ~t~,..~...e...~. .................................................................................. (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 fil this application; that~ll statements contained ir~t'h~s application are true to the best of his knowledge and belief; an. tha~ the work will be,~erformed in the manner s~f'6rth in the apg~ation filed therewith. Swam t re me is '~ ............ "_ ........ ..... 77::-:",' ............................ Notar/ F'ublic.~...~/~~...:.~r...~'~..~,~.~...~dqty (Signature of applicant) .......... / / RUSSELL K. PERRIN~ / t I~otar~ Public State of New ~',~!, ~ Residing in Suffo k Ccunt'/ S~f~tk County Clerks Ho, 52-306~ 33 ~,omm*~'~on Expires March 30, 19 '7 !