HomeMy WebLinkAbout5161-zrOBM~NO. I
'TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTI,IOLD, No ¥o
Examined ~[,u~-/X 19.Z./'
^pproved ........................................ , ]~ ........ Permit No ...........
....................................................... ~O(Building InspectdD --' ~1. ~ ~).q o ~
APPLICATION FOR BUILDING PERMrT
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, relationship to adjoining premises or public streets or
areas, and giving a detailed description of layout of property must be drawn on the diagram wl',ich is part of this application.
c. The work covered by this application may not be commenced before issuance of Building Permit.
d. Upon c~oproval of this application, the Building Inspector will issue o 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, ordinances, building code, housing code, and regulations.
Robert Deuglas
(Signature cf applicant, or name, if a corporation)
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, generaJ contractor, electrician, plumber or builder.
.................................... 0~zz~l:..-i~il~e.~. ...........................................................................................................................
Name of owner of premises ...... .~'...e..~..e...~..~....D..~.l~l~..~.~l. ............................................................................................................ L
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.: ....l~l~.le.w...~.e.~r.e.g.e... Lot No.: ...~.~,~'~ ............
Street and Number ...P.l:~.~a.~..~Le,_nd....Jt/:Ll,~ew...T&~,¢~ ....... :~...0~.~.~, ................ .~
· )z~ --/.~'~'~ --~ (~u~n~_. o~ Munici~li~ ................ ~
2. State existing use .gd ~cu~ncy of P,mises and intended use and occupancy of prop~ const~ction: ~,
.
a. ~ist~ use and ~cupancy ....~.~...~.~...~.~&~.~ ........................................... ~
b. Intended use and ~cupanm'....~.~...(.~.~.~..~.)...~ ....................
3. Nature of wink (check which applicable): New Building ..... ~ ........Addition .................. Alteration ..................
Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................
4. Estimated Cost ........lg~lO~...'f. ....................... ~ ........... Fee ....~.....0...0. ............................................................................
(to be paid on fi!lng this application)
5. If dwelllng, number of dwelling units ..... ~,D,g ............. 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 ..... U.tili.~. ......
7. Dimensions of existing Structures, Jf any: FJont ............................ Rear ................................ Depth ....................
Height ........................ Number of Stories .................................................................................................................
-' Dimensions of same sfructure with alterations or additions: Front .................................... Rear ............................
Depth ................................ Height ............................ Number of Stories ................................
8. .Dimeqsi0ns .of entir~ new construction: Front ............. :~(~ .................. Rear ...... .1~) ................. Depth ...... .1.~. .............
Height .................... Number of Stories ...... el').~ ........................................................................................................
9. Size of lot: Front ............................ Rear ................................... Depth ................................
10. Date uf Purchase ........................................................ Name of Former Owner ........................................................
! 1. Zone or use district in which premises are situated .......... .".A.n....~,S.~. .......................................................................
12. Does proposed construction violate any zoning law, ordinance or regulation? ............ ~& ..........................................
13. Name of Owner of premises ~e~..,~l~.lz~'la,S. ........... Address ......... 0~.:L~-'~ .................... Phone No .....................
Name of Architect ...................................................... Address ............................................ Phone No .....................
Nome 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 names and indicme
whether interior or corner lot.
STATE OF NEW YORK, IS.S ~'C) /'~ I C/~'J' /~ 4 /~10
COUNTY OF .8~1~£e-1~ .............. ~ '
.................................... · ~I~G.Z~...D~I~j.].&~ .......................... being duly sworn, deposes and says that he is the appJicant
(Name of individual signing application)
above named. He is the ........................... O~,rm.~..,~..huzLil.~- ................................... jL .......................................................
(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 oil 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
Nora,-, .............................
(J ELIZABETH ANN/NEVILLE ... /~1 "--J]/']~"~ ' ~'/ '
NOTARY PUBLIC, StaJe of New York ~ ~
No. 52-8125850, Suffolk Cou,~
Term Expires March 30, 19~1
FORM HO. ~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
CT'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 5161 Z
Pe'rmission is hereby granted to:
to ...~.. ~i~...~1~1~ .................................................................................................
.Building Inspector.
Fee $....~ell~ ..........
at premises located at ................. tPm~k.-.a~l'~--wi'--'l~t~.1~-,Je~l~ee--tJlJl~i,~tsJ:J.~ .............
............................. .:.....i~t.. llm~...Oi'.IL,~,.j~ ..Lt~.at~ ............ O'l,'tJ~t,. .......................................
pursuance to application dated ................... ~....j~ ....... .jJJ. ................ , 19...?.!~, and approved by the
J~)BM' NO, !
TOWN OF Sou'moLD
IUILDING
TOWN CLEIK'S MI:ICI
SOU'mOLD, No ¥o
Examined ....................................... ,19 ........
/..(./. ·
,~re~:l ........................................ , 1~ ........ ~ermlt No....;; ...... ' .':/..
~i~pprov~ a/¢ ........ U>:
.................................................................. ........................
......................... {Building
Application No.....~.../...~.~ .............
AFI)LICATION FOR BUILDING PERMrl
nm. 14arch 12 19.~.J .......'
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building
Inspector.
b. Plat plan showing location of lot and of buildings on premises, relationship to adjoining premiee~ or public streets or
areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of thie 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 Jmpector 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 he occupied or used In whole or in port for any purpose whatever until a Certificate of Occupancy
shall have been granted by the Building Inspector.
APPLJ~C~TION IS HEREBY M~DE to the Building Department for :the issuance of a Building Permit pureuant to the
Buila"mg:7one 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 lows, ordinances, building code, housing code, and regulations.
' ..... ................................ i ........................
(Signature cf applicant, or name, if a corporation)
.......... 13rtent ........................................................................
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
.................................... · ~e~.~t~u~.~.ei~r ...........................................................................................................................
Name of owner of premises ...... ~cb~r.t...D. an~la-~ ............................................................................................................
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.: ....~.i~ '1 ~.~...~.~Z'~.:~,.C.e.. Lot No.: ...~c ...........
Stoat and Number -...~vet--.fie~.....~i.~.~.e~F...~.p~ee ............ G~'.~.,e~t, .....................................................
Municipality
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ..... F~C~..I'.~...~U.J~L.~..V~c~.i.0~ .............................................................................
b. Intended use and occupancy~.....~Z~.£t.~'...~,_~t~e,~e...e.tc.)...b~:L~,i,~ ...................................................
3. Nature of work (check which applicable): New Building .... ;3~.. . Addition .................. Alteration ..................
Repair .................. Removal .................. Demolitic~n .............. :~.. Other Work (Describe) ........................................
4. Estimated Cost ....... ~.~.04~O-..~ ................................... ~Fee ,..~.~ .....................................
' ' (to be paid on fi~ing thi'~ applicati~) ...............
5. If dwelling, number of dwelling units ..... i3~LEuE, ......... ..~Number of dwelling units on each floor ............................
If gorage, nu .tuber of cars .................................................................................... : ........................................................
6. If business, commercial or mixed occupancy~ specify nature and extent of each type of use .....~t,.~..~.t,~'. ......
7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth ....................
Height ........................ Number of Stories .................................................................................................................
Dimensions of same structure with olterotions or additions: Front ....................................Rear ............................
Depth ................................ Height ............................ Number of Stories ................................
8. Dimensions of entire new construction: Front ............. t~- .................. Rear ...... ~e ................. Depth ..... .~.~ ..............
Height .................... Number of Stories ...... a~e ................ ; ........................................................................................
9. Size of lot: Front ............................ Rear .................................... Depth ................................
10. Date of Purchase ........................ ~...:.....~ ..................... Nome of Former Owner ........................................................
11. Zone or use district in which premises are situated .......... ~'.,,?...~.~L~t, ........................................................................
12. Does proposed construction violate any zoning law, ordinance or regulation? ............ a~ ..........................................
13. Name of Owner of premi{esJ~e~t,..~e~tl[~L~& ........... Address ......... C~'.J,e~J;. .................... Phone No .....................
Name of Architect ...................................................... Address ............................................ Phone No .....................
Name of Contractor ...... ~a~e .................................... Address ............................................ Phone No .....................
PLOT DIAGR,~A
Locate clearly ond distinctly all buildings, whether existing or proposed, and indicat~ all set-back dimen, sions from
PwherOetth?rr inlJt~r GoirVceo~mermeltotand block number or description according to deed, and show street hames and indicate ·
................. YZY ......... ;':'"~e~"~e~[~ ........ ; ................. ~i~ duly s~rn, d~s and says t~ he is the applicant
[mame ot ~nalvlaual slgnl~
a~ve named. He is the ........................... ~e.~ ..... ~e~ .................................. '~ .......................................................
(~ntmctor, ~t, co~mte officer, ~c.)
of said owner or owners, and is duly aut~riz~ to pedorm or h~e pe~o~ the said work a~ to ~e ~d file
this application; that all statements contain~ in this applicati~ am tree to ~ ~st of his ~t~e a~ ~lief; and
tha~ the work wdl ~ pe~o~d in the manner ~t fo~h in the a~licati~ fil~ ~er~i~.
Sworn to ~fore ~
............... .................. . ' -
No. 52~2~50, Suff0~ Coue~
Term ~Jres ~arch 30,