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Home My WebLink About5956-zTOWN OF SOUTHOLD BUILDING DEPARTMBNT TOWN CLIqtK'S OFFICE SOUI'HOLD, N, Y, Examined ..... i~ !~ .............. , ........ , p,co,on ............ Approved ...... u- .................. ~ ............ , 19 ........ Pemit No ..................................... .................. /--~C~..i;;~i;~;~. ................................. ~',~ A"LICATION FOR BUILDING Dote ........... ~ .................... , 19 ............ I NSTRU~IONS a. This appli~tion must ~ completely filled in by ty~writer or in ink and submitted in triplicate to the Building Im~or, w 3 sets of plans, a~urate plot plan to. scale. Fee a~ording to sc~dule. b. Plot plan s~wing location of lot and of buildings on premiss, relationship to adjoining premiss or public s~ or are~, giving a detailed description of layout of pro~rty must ~ drawn on diagram which is pa~ of this appli~tion. e. The wo~ ~vered ~ this application may not ~ commen~d ~fore issuan~ of Building Permit. d. U~n approval of this application, the Building Ins~ctor will issue a Building Permit to the applicant. Such ~rmit shall ~ ke the premiss available for ins~ction throughout the work. e. No building shall ~ occupied or u~d in whole or in part for any purpo~ whatever until a ~rtifi~te of O~u~n~ shall ha~ gr~ by the Building Ins~ctor. ~PPklC~TIO~ IS Hfi~fiB~ ~D~ to th~ 8uildin~ D~rtm~nt for th~ i**u*n~ of a 8uildin~ ~rmit ~u~u~nt to t~ 8uildi~ ~o~ Ordin~n~ o~ th~ Town of ~uthold. Suffolk Count~, ~w York, ~nd oth*r building, addition~ or ~lt*ration~, or for r~mo~al or d*molition, ordinances, buildin~ cod*~ hou~in~ cod~, ~nd r*~ul~tion~, and to ~dmit authoriz~ in~etor~ on (Signature of applicant, or na?, if a corporati~pn) _ / State whether applicant is owner, Ieee, a~nt, archit~t, enoin~r, ~nera con r~ or, e ~rician, p um~r or ui oer. ,,m, o, o,,,r o,,,,mi., ........... : .................................. ........... If applicant is a corporate, sionature of duly authorized officer. (Name and title of corporate offi~r) 1. Location of land on which proposed work v~ill be,cl~e. Map Nq.: ..~f~...~.... .............................. Lot NO/..~.~... Street and Number ....~.~..~..~......~~_~g~.....~G~:~,_~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction'. occupancy ....... .~..~.. ~. ....................................... ,., .... ~ ............................ , ..................... ~'~ a. Existing use and b. Intended use and occupancy .~ ....... ~.~~..~. .................................................. ~ 3. Nature of work {check which applicable): New Building ....................... Addition ..................... Alteration ............... Repair ......................... Removal ................... , ...... Demolition ........................ Other Work .~....~ !Description) 4. Estimated Cost ...~'-'J~ ............... ,. Fee ...i. ...... , ..................................................................................... (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 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 .....................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 ...~.....~'..~... Rear .....~..~/, ....... Depth ....~..~....;~, ...... Height .......... .~..~ ...................... Number of Stories ......................................................................................... ~! ~'~ _~-- ~'~ .. 9. Size of lot: Front ...... .{. ~Z. .... .. .. ................ Rear ...~;...~.~ ............................... Depth ...... ,.~ .......... , ..................... 10. Date of Purchase .....~..~...~..~.'~- ................. Name of Former Owner ..... ~.~".......x~...~ ......... , ........... ,~__ 12. Does proposed construction violate any zoning law, ordinance or regulation: ............................................................ 13. Will lot be regraded ......... ~ ........ WilJ excess fill be removed from premises: [ ] Yes [ ] No 14. Name of Owner of premises ....',~...~....~.~ ........................ ~...~..~.....-~...~ .~...~ ........... (Address) (Phone No.) 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 sat-back dimensions from iproperty lines. Give street and block number or description according to deed, and show street names and indicate wbeth- er interior or corner lot. Jc~ / ~) ~ STATE OF NEW~ ) COUNTY O~ ................ ) .......................................................................................................... being duly sworn, deposes and says that he is the applicant above named. (Name o/individual signing contract/ He is the ................................................................................................................................................................................................................. (Contractor, agent, corporate officer, etc.} of said owner or owners,,,_, ~, ~n~ ~,~ = ~ x~,.,v~,~-- and J~D~Tu~vT',a.~l~l~t[~llzed to perform or have performed the said work a~d to make and file this application; that all statements contained in.~l.~i~/~=~r~Eot~o~u~t~h~, best of his knowledge and belief; and that the work will be performed in the manner set forth in the app|ica~l~'~l~,ch oo, 1;~-'~ .............. ........ , , _ ......... o? ,, ........................... FOI~M NO. 2 TOWN OF Sou'rHOLD 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? 5956 Z Permission is hereby granted to: Dona:Id GI'e~ & ~.fe ....... ....... ~outhol~ at premises located at ~o.$.i.J.O~.....~.o~i3,d.~s.,]~at&te~l: ................................ ............................................... m~..~,t~~'t.~ ........... a~t~o~ ........... ~,~.,....,. .............. pursuant to application dated .........................~....i~....e ........ ~.~. ...... ..., 19...~..., and approved by the Building Inspe~:tor. : Building Inspector FOI~M NO, 1 TOWN OF SOUTHOLD ; BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ................... (..~ ........... 19 ........ Approved ~ 19 ........ Pemit No. Z.~...~ Application No, .....~.,..~...,~...~:. ............... Disapproved o/c ................................................... ~ .... (Building InspectoJ') APPLICATION FOR BUILDING PERMIT Dole ............... ........... .... INSTRUCTIONS a. This apphcat~on must be completely filled in by typewriter or m ink and s,,ubm~tted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Pict plan showing location of lot and of buildings on premises, relationshitJ to adjoining premises or public streets or areas, and giving a detaded description of layout of property must be drawn on diagram whiqh 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 Budding Inspector will issue a Building~, Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whlatever until a Certificate of Occupancy shall have been granted by the Building inspector. APPLICATION IS HEREBY MADE to the Budding Department for the issuance of a 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 demoht~on, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, hous~ ng code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name,,if a corporat~n) State w~her applicant is owner, lessee, agent, architect, engineer, gene!al contractor, electrician, plumber or builder. ........... ~, ..~....~d.-:'/~,., .~...~... .................. ¢~ ................. ~.. ......................................... ~ ........................................................................ 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 wozk w II be done. Map No: . ~?,..~,,, ..~... Lot NO//~/) ;~ Street and Number ....~..~...~.~.....~Z.~ '~ ,.~'/ .......... ~il.'i.':i.'il.'i.'iiiiiiil.'i.'.'.'.'ii.'i.'i.'iMunicipality ............. 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..~ ................... ~ ...... ,~...i ........ .et ..... J ..................................................... b. Intended use and occupancy...~..~-..,~.,~.,~.,~.,~.s~... .......... '~....~ ...................................................... 3. Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration ............... Repair ............. . ............ Removal ......................... Demolition ........................ Other Work I Description) 4. Fstimated Cost ....~~ .............. Fee ..................................................................................... ; ........... (to be paid on filing this application) 5. If dwelling, number of dwelling units .................Number of dwelling units on each floor ............................. i ........... 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 .....................Rear ........................... Depth ................................... Height ........................................................... Number of Storms .................................................................. ' ........... Dimensions of same structure with alterations or additions: Front .......................... Rear ......................................... Depth ............................................. Height ......................................... Number of Stories ...................... ,..,- ............. 8. Dimensions of entire new construction: Front ...../.~)~.~........~/ Rear ...../...Z~...~-- ~' ......... Depth ......?.:/...~... ............ Height ................................................. Number of Stories ......................................................................................... 9. Size of ot' Front . .~'...~...'~.~.'~.. ............... Rear ...... .~.~..~...~.'~.. ..... Depth ..;.~...~....~.~ .......... i ............ 10. Date of Purchase ./..~.. '~.'~.'~ . Name of Former Owner ~ .......~.~ .................. 12. Does proposed construction violate any zoning law, ordinance or regulation: .......... ~'-~...~;;'.; ................... ; ............ 13. Will lot be regraded ..... '~..4~........~ ............ Wi~J excess fill be removed from~premises: [ ] Yes [ ] No 14. Name of Owner of premises ...~~..,Wrr....~ .~ ............... ~..~'.~...;:u..~.: .~.~ ........ (Address~' tt'none ~o.} ~ Name of Architect ........ ..";%..;,......-%...~ ........................................................................................................... __.. Address (Phone No.) i Name of Contractor ..........~.: ................................................. (Phone No.) l(Address) PLOT DIAGRAM I'ocate 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 indicate wheth- er interior or corner lot. ~ .......................................................................................................... being duly sworn, deposes and says that he is the applicant above named. (Name of individual signing contract} He is the ................................................................................................................................................................................................ ' ................. (Contractor, agent, corporate officer, etc.} of said owner or owners and is dud authorized to perform or have performed the said work and to make and file this application that all . . JUDIT T .... statements contained In this qfN~[ication. ~[~ t~Etr~the best of his knowledge and bel ef; and that the work will be performed In, the manner set forth n the app cat on f I~fl ~ek'eJ~(b~. ~ ~ . : : ~ {Si~a~re ol appacanu