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Home My WebLink About6003-z FOBM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT 'tOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT. (THIS PEPu~IT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 6003 Z Permission is hereby granted to: ~'~..G~S~ ....................................................... .......... · ~"~ ....... (Cai7) ............................. at premises located at ..... 87~...i~1,~...~;(1 ............ ~P~I~.~') ........................................................... ..................................................... Gt, eeal~ ......... N-~¥.~ .................................................................. pursuant to applic~lon dated .I&~...'I.~.F.~.t.~...~/I19.~i~.., and oppro~ed by the Building Inspector. Fee $'~00 .......... ~OKM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN GLERK'$ OFFIGE SOUTHOLD, N. Y. oZ3'Z Approved 19 ........ Pemit No ..................................... Disapproved a/c ..................... ~._..._... .............................................. :. (Building Inspector) 6 o Application No ................................. APPLICATION FOR BUILDING PERMIT Date Jl]]y 1 1 "/2 ~ 19 ............ INSTRUCTIONS a. This apphcation must be completely filled in by typewriter or in ink and ~ubmitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee accordmg to schedule. 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 diagram whi(~h 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 wdl 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 Building Department for the issuancb of a Budding 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. ]-he applicant agrees to comply with all applicable laws. ordinances, building code, housing code, and regulanons, and to admit authorized inspectors on premises and in buildings for necessary inspections. rom.. Geier (S~gnature of apphcant, or name, if a corporation) ..lt.oz::~i.......l{cl ........ O.r.c~p.oz:~ ........................... (Address of apphcant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................................ g~.~. ,.~ r;'.z ....... b.~,l .:~, ,k~,, ~ ................................................................................................................... Name of owner of premises ...... O.g.kx.....~..f,~.,.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.: .............. .x...~. .................................. Lot No ....... Street and Number ................. ~./.~...g.o.;~.q~)2..~i,c~!.~, ...... g.~:',~'.. ...... fi~.~i'~.~o~'.% ........................................................ Municipality 2. State existing use and occupancy of premises and intended use and occ~Jpancy of proposed construction: a. Existing use and occupancy ..~.~.c.:.c.L(.`~{;'~L©~`.~.~ji.7~j~.ji~]~%~g...(.~A~.~='g~T~j~g~..h~). ............................ b. Intended use and occupancy ..~.v,W~;...tiJ];};,..f:~:Ct.if.O.Z:.~J~.ol~....~¢z~..hiu%;L,..[~L~,a, .................................................. Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration.......~.~'~.. Repair ............. . ............ Removal ......................... Demolition ........................ Other Work .................................... IDescription) Fstimated Cost ............... c..Q ? D. Q0...~. ............. Fee ....... ~..~., ~).Q .............................................................................. (to be paid on filing this application) If dwelling, number of dwelling units .....~ ..........Number of dwelling units on each floor ......................................... If garage, number of cars........................ ........................................................ .. . · If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................................... Dimensions of existing structures, if any: Front ..... ~[~ ........... Rear ........ ~;Q .............. Depth .......... .~.O. .................... Height ........................................................... Number of Stories ....... ~;:v~'.c~ ............................................................... Dimensions of same structure with alterations or additions: Front ........ s~e .........Rear ......................................... Depth ............................................. Height ......................................... Number of Stories ........................................ 8. Dimensions of entire new construction: Front ..... ..~..o.~.e. .......... Rear ............................ Depth ................................. Height ................................................. Number of Stories ......................................................................................... 9. ~" Depth .................................................. o~ze of lot: Front ...................................... Rear .......................................... 10. Date of Purchase ..................................... Name of Former Owner ............................................................................ ..... i~ ii c ' s' 11. Zone or use district ~n which premises are s tuated ............. ~ ........ ~,...J~. .................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ............... ;ac ........................................ 13. Will lot be regraded ...... .~...o. ....................... Will excess fill be removed from premises: [ ] Yes ~] No " ·" r Green crt 14. Name of Owner of premises ..... .J..9..~.~..~.e..~.?.. ................................................. .~.....~.....; ............................................... (Address) (Phone No.) Name of Architect ..................................................................................................................................................... (Address) (Phone No.) Name of Contractor sa[~e ...................................................................... (Address) (Phone No.) 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. See .~'~led plans dated July 1971 STATE OF NEW YORK, ) ................................................. ~].O..~.!~,L...g.~..,~..,O.?.. ............................. being dulv sworn, deposes and says that he is the applicant above named. (Name of individual signing contract) He is the .............................................................. .0.~?.Z~.~.~?....-......~...l~.~].~..~..~.q~' .......................................................................................................... (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.e 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, ........................... .~.~......day of ...................... ~[ILI~. ................. 19 ..~. .........//'] /~ ~ 0//~.. ~'.~ Notary Public ...................................................................... County ........... ~ ..~..i-.f.....C~..../~.. ............ ~,,.~.,, ................................................ Z~ (Signature of applicant)