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Home My WebLink About5953-z FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL cOMPLETION OF THE WORK AUTHORIZED) N? 5953 Z Permission is hereby granted to: at premises located at ~t. 2 ]~1~'~1- (~lll~t,~ lt'lt~t, el ............................................... I~l,~z..D.~t,.e .............. I~'~1. ....................................................... pursuant to application datod ................... ~'.~ ........~.~ ............... , 19...~., and approved by the Building Inspector. ui ding nspector ~, '5 %.o\ '0 0 0~ SURVEY FOR MIL--MATT AGENCY, INC. LOT 2 "LAUREL COUNTRY ESTATE°S" LAUREL TOWN OF SOUTHOLD SUFF. CO., N.Y. CUARANTEEDTO, SECURITY T{TLE & GUARANTY CO. SCALE: I"= 40' SOUTHOLD SAVINGS BANK JULY 16, 1970 OCT. 2, 1970 PROFESSIONAL E~GINEER AND LAND SURVEYOR.N.Y.S.LIC.NO.IZ845 RIVERHi EADI NO l= MONUMENT SUBDIVISION MAP FILED IN THE OFFICE OF THE OLERK OF SUFFOLK COUNTY ON JUNE 22, 1970 AS MAP NO, 5486. Examined Approved FOEM NO, 1 TOWN OF SOUTHOLD BUILDING DEPA. RTN~ [NTI TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ( > 19 ........ ........................................ , lY ........ Pemit No ..................................... Application No. ~'~'~'~-~ Disapproved a/c .......................................................................................... .. (Building Inspector) APPLICATION FOR BUILDING PERMIT 'Date ......~....~...~:.~.~......./..'~ ........... , 19....~.?.....~. 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, relatidnship to adjoining premises or public streets or areas, and giving a detailed description of layout ofproperty must be drawn ~n the diagram which is part of this application. c. The work covered by this application may not be commenced befor9 issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue b 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 ~'~ork, 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, buildiJng code, housing code, and regulations. (Signature of applicant,' or nam ,c,~if a co~ration) ' ' * (Address of applicant) ~2~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..................... ::::-. ......... ................................................ .......................................................................... Name of owner of premises ................................................................... ;;... ................................................................ ~... 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.: ...~...z........ ...... ~ ................... Lot No...~.:-: ................ Street and Number ................................................ .~ ..................... , Munir,~ality 2. State existing use and occupancy of premises and intended use an~ occupancy of proposed construction: a. Exisiting use and occupancy ........ :....~:~ ........... ~ .................... ,~..: .............................. ~ .................................... b. Intended use and occupancy ,~:~.~/.?~' '::'::'"'u':.'>.")'" .................... ............................ ....................... :" .............. Natur~ of w(~rk (check which applicable): New Building .................. Addition . ,/. Alteration 3. Repair .................. Rer~oval .................. Demolition .................. Other Work (~ri~'~i".~..'~ 4. Estimated Cost ........ ..~L(.'¢~..]......~.. ................................ Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ....... ../.. ................. Number of dwelling units on each floor ...-?.. ..................... If garage, number of rs ~' : 6. If business, commercial or mixed occupancy, specify nature and extent of eac, b type of use ............. ~ .............. 7. Dimensions of exis}~g structures, if any: Front .....~......7.......: ........... Rear .....?~./~.. ....................... Depth ~..-~.., .......... Height ........ ./.....'~... ....... Number of Stories .../... ........................................................................................... .............. Dimensions of same structure with alterations or additions: Front ~s-zc~x ~ ,x / .................................... Rear ...%~. ,~......~.. ............. /~'~ / Stories ....L ......................... Depth ..... ..~. Z../.] ............... Height ............................ Number of 8. Dimensions of entire new construction: Front ..~'~.~ .................... Rear ............................ Depth ........................ Height .................... Number of Stories ..................................................................................................................... 9. Size of lot: Front ........... ,/'.~-....../. ..... Rear ..... ./.;...~....:. ................. Depth ...... ..~....~...: ........ 10. Date of Purchase. ../..fY. ../'..~....~.~... - ............. 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? ..~ .................................................. 13. Name of Owner of premises .~..~....~...~..~..~..../...~'.....~ress ..~...(-~...~:.~,.',~,..~....4~....~...'~../....'~..~.~one No. ~-'.~,..~.T~..~- Name of Architect ............... ../....?~...~....~. ........................ Address ............................................ Phone No ...... : .............. Name of Contractor ............. ~.~...~/...: .....................Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether i'nterior or comer lot. STATE OF NEW,/~', O~R~f(~ j~ . ~S S COUNTY OF ~:.(~......f ' ............................... .:.1.. ............. .................................... T..~.being duly sworn, deposes and says that he is the ,applicant (Name of individual signin~ application) above named. He is the .............. ~.'~../.(.~?.~..'~') ...................................................................................................................... (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 application filed therewith. Sworn to before,me this ........ of ......... / } ,'~ ] z? .~ "'/~-", /J .......... .,C.I...¥-r/. .............. L~.......~....~....~..,~... ........ /"t .............. Notary PubIi~.....~/....:.L.~..~....~C~C. aunty ~ (Signature of appJ~nt) ,/ l ~' JUDITH T. BOK~N '