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Home My WebLink About5887-z ~ORM NO. 2 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? 5887 Z Dote ........................ M ....... .~.8." ......... , 19~... Permission is hereby granted to: ..... ...~..~...*...J~.;I;~.., ..~ ............. at premises located at ............ ......... ~-~ ..~%~ .... I1,¥, ........................................................................................... pursuont to opplieotion doted ........................~'~'~.-..~9 ......... , ]9.~,.., ond opprovecl by the Building Inspector. Fee $.t.f.eO ........... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ......................................... 19 ........ Disapproved a/c ............................................................................................ ............................... ....... ........... ........................ ................................. Application No ................................ APPLICATION FOR BUILDING PERMIT Aoril lh v- Date ................................................ , 19~ .......... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. O. 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 diagram which 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 Building 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 whatever until a Certificate of Occupancy shall have been granted by the Building Inspector, APPLICATION IS HEREBY MADE to the Buitding 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 demolition, as herein described. The applicant agrees to cornply with all applicable laws, o~dinances, building code, housing code, and regulations, and to admit authorized inspectors o..~E.~mises and in buildings for necessary inspectioos. ( 'g pp ' , , 'f/~corpo Private ){oed Goose Creek (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Owner Name of owner of premises ...,~)be.~q~..i,,...P.h.y.~..],.i.s..l~;a.l.l.g.~af. .................................................................................. 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.: .................... Lot No .............................................. Street and Number ~'T IZ.~Jlc,..~Q~.~...o.~'.C...I']D.r.~..~.a~...~/.i.e.~..~.ct, .................................................................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....~.~..i...~.~.~.~l,...~.Q~...b.~.a...m..~.],~. ............................................................................ b. Intended use and occupancy ..~.~..d. ff,U.,~.~,]....Q~g.e...~,~i.].~ ............................ : ............................................... 3. Nature of work (check which app' Repair ......................... Removal ble): New Building ....................... Adr' 3n ........,.TZ~.,. ........ Alteration........'~...~l,' ......................... Demolition ........................ Other Work .................................... (Description) 4. Estimated Cost .: ....... LL...; .............................. Fee ......... D.1,5.,.~.O. ......................................................................... (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 'Ho ................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use.. ................................... 7. Dimensions of existing structures, if any: Front 36 Rear 36 Depth 30 Height 20 ~ Number of Stories ....... ..O~...e.. ............................................................... Dimensions of same structure with alterations or additions: Front.....,....................22 Rear ...... ,3.,6. ............................... Depth ........ 7,~; ................................. Height ............ 2..0 ........................ Number of Stories ......... ~a ........................ 22' ' 8. Dimensions of entire new construction: Front ......................... Rear ................ ~,,~ ........ Depth ....... 4 ~ ...................... Height 21 Number of Stories One 9, Size of lot: Front ......7..~ ............................ Rear ............. ~¢ ........................ Depth ........... 2.1._~ ............................... · One . . Height....................................................21 Number of Storms .................................................................................... 10. D~te of Purchase ....1..~.~] ......................... Name of Former Owner ....S..a.~r.O.~...~...~.~],¥o,g ........................................... Residential 11. Zone or use district in which premises are situated ..................................................................................................... Not to My knowled¢;e 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................... .~ ................ Yes 13. Will lot be regraded ................................... Will excess fill be removed from premises: iX] Yes [ ] No Robert & Phyllis Mallgraf. 765 2137 14. Name of Owner of premises ....................................................................................................................................... (Address) (Phone No.) Name of Architect ........................................................................................................................................ · (Address) (Phone No.) 765 2137 Robert C. Ma~lgraf ..... Name of Contractor ............................................................................................................... (Address) (Phone No.) P10T 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 indicate wheth- er interior or corner lot. STATE OF NEW YOR~, _/x/, . , ) cou,T o, .............. ~[~¢~Z¢~'~ be no du v sworn deposes and says that he ,the app cant above named. [ Nom~ ind~bual s{~J~ contract) He ~s the ....................................................................................................................................................................................... ~ Co~tr¢clot, ~t, corporole o/~cer, etc.) of said owner or owners, and is duly authorized to ~rform or have ~erformed the said work and to make and file this application; that all I · B KEN statements conta ned n this appl cation are true to the 8~)s ~J~nd ~liaf; and that the work will be ~rformed in the ~nner No~o~ set forth in the app ca~ on f ed therewith. ................. o,...: .............' Notary ~ub 'c~.~: .~....¢ ............................................................................ ~'~ ............................ ~/ I (S~m~ Of appli~nt) /'