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Home My WebLink About6014-z FORM NO. 2 TOWN OF $OUTHOLD 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) No. 6014 Z / / Permission is hereby granted to: ~:'i:,:~ ~: 7 >) /:'~ :' ~ /~ ........... ' ........... : ............................................. at pr,raises located at .......................... ~ ........................................................ ' :? ~ ~:[/~/~ 1~.., and opproved by the pursuant to application dated.,..' ................. : ...................... ~ ...... t~"'", ~uilding Insp,ctor. FOI~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE' SOUTHOLD, No Y. Approved ..................... ..z/.../...~......, 19.~..~.. Pemit No. Disapproved a/c ....... ~.,~ ............................................. Application No...~. ~..~.. ,/...~... ................ (Building Inspector) APPLICATION FOP. BUILDING PERMIT ......... ............ i ....... ..... I NSTRUCTION5 a, This application must be completely filled ~n by typewriter or in ink and submitted ~n triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according 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 detaded description of layout of property must be drawn on diagram which ~s part of th~s application. c. The work covered by this application may not be commenced before issuance 6f 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 budding shall be occupied or used m whole or ~n part for any purpose wt~atever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Budding Department for the issuancb of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances ol Regulations, for the construction of buddings, additions or alterations, or for removal or demolition, as hereto described. The apphcant agn all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on ,,r necessary inspections. (Sigl (Address of a State whether apl~[~c~nt is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on w~hich proposed work will be done. Map No.: ....... i ............................................. Lot No ............. Street and Number ,...~.~.....,~....~.¢..~,....~* .......... .~,..~ ........ )..~ ................ ..~/. ............................... ~ ...... ..-.:.....: ............. r ~ ) Mumc~pahty 2. State existing use and occupancy of premises and intende7~ use and occupancy of proposed construction: a. Existing use and occupancy .................. . .~. ~....~..c:~....~¢..'! ............. ~ ....... i ................. : ...................................................... b. Intended use and occupancy .......... ..~...~....~....c....~ ................. ~.~,q.,.~:..c?...~?;., ................................................................. 3. Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration ............... · / -~2~ ~-~ Repa r ........ ,~moval .........................Demohtion~,; ...................... Other Work ........~..~.. ................... 4. --stimated Cost ......~..~.4.d.~ ................. Fee ............. ~...~.~., .............. : ......... : ......... t ................................. ~f (to be paid on fi ing th s appdcationl 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 tvpe 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 ..................... 2 .................. Number of Stories ........................................ 8. Dimensions of anti? new construction: Front ....~....~. .......... Rear ............................ Depth ................................. Height ........... 3 ................................. Number of Stor es ..... r' ................................................. ~2 .................. · ' ) ~ ~ 0 9. ' ....... ~ "Q '~'"'?"/" ................ :~ ('~ ~ © (/''-A Det ~-.?~ Size of lot: Front .~..~)..J../. Rear .......................................... P b ......~ ........................... v...~'" 10. Date of Purchase ....'). ............... ./. ........ Name of Former Owner ...~..~...~.....~...~-~..?..~..4..?..~..~...~..~.;~..~.(.i.~...~..~'..~....~....~.. 11. Zone or use district in which premises are situated ........ ..~... ............................................. 7 ....................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ......... ..~....~....~.: ...................................... 13. Will lot be regraded ........................... .~.. Will excess fill be removed from Dremises: ,[ ] Yes [ ]~No 14. ~ame OT uwner oT premises ............... ~ ......................... ~. ........................ ~.~ ......... / ........ , ................................ ', .... (Address) (Phone No.) Name of Architect ...................................................................... i~,~;~;~'~i .................................................................. (Phone No.) Name of Contractor ................................................................................................................................................... (Address) (Phone No.) PLOT DIAGRAM Eocate clearlv 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 YORK ..... ~ ) COUNTY OF ................... ~.¢...(.'~ ...~..(..~ .......... ) SS ........................ H..~...~....~...y.....~....~..~..~..~ .................................... being dulv sworn, deposes and says that he is the applicant above named, (Name o~' individual signing contractj He'~s the ............. (Contractor, agent, corporate officer, etc. J of said owner or owners, and is dulv 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 t,he best of his knowledge and belief; and that the work will be performed in the manner set forth'~n the apphcat' on f ed therew th ~xi ~o >, , ' ',- ,,,,i,, , ~ t, , .. /'/ -- ................ L'.-/ ............... d.y o, .......... Notary .................. . ..................................... ~' ~ 7 - (~g~iature of applicant] TOWN OF SOUTHOLD BUILDING DEPART/v~ENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Yo Examined ......................................... 19 ......'.. Approved ........................................ , 19 ........ Pernit No. ' Disapproved a/c ............................................................................................ Application No ................................. (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ........ ...................... ,,,..?.Z .... INSTRUCTIONS a, This apphcat~on must be completely filled in by typewriter or ~n ink and ,ubmitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buddings on premises, relationshi to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on diagram whioh is part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approva[ of this application, the Budding Inspector will issue a Budding 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 Budding Inspector, APPLICATION IS HEREBY MADE to the Bui[ding Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffo[k County, New York, and other applicable~Laws, Ordina~ces or Regul :ions, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described, ~l-he applicant agrees to ~licable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on ? (Signat~e'~f or name, if a corporation) (Address of apphcar~ State whether applicant/~'~, wner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .......... ~ ,L ~J./. ~.~..~?~ ............................................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on whiqh prop, Qsed work will be done. Map No.: ......................................,......~ ...... Lot No ............. Street and Number ..... Z.~. ...... ~...~..~..../.~..~ ...... .-~'¢.;, ...... ~....~)..,..~...~ ......... ....... .~../.....~ ...................... ~'~'~i~ii~'ii~ .......... 2. State existing use and occupancy of premise~ and intend~ use and occ~Jpancy of proposed construction: a. Existing use and occupancy ................. Z(~..['..~.~..~.....,.,~ ............... ; ........................................................................ b. Intended use and occupancy .......... .~. ........................ .~...~.; ............. ~ ........................................................................ 3. Nature of work (check which applicable): New Building ....................... Addition ..................... Al~ation ............... Repa r ... ......... I~emoval ........................ Demoht~on..,~. ..................... Other Work ............................... f~] r~ /l ~[~/'/ ,~.~ (Description) 4. I. stlmated Cost .................... ~; ........................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 cars ............................................................................................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................................... 7. I)imensions of existing structures, if any: Front ..................... Rear ........................... Depth ................................... Height ........................................................... Number of Stories ............................................................................. Dimensions of same structure with alterations or additions: Front .......................... Rear ......................................... Depth ............................................. Height ............... ;, ........ ;7 .............. Number of Stories ........................................ 8. ::~sions of e ~:e ~)ew construct:on ::j~)te:.~SSt:i -~s. ....... Rear ............... : ............ D;~th ................................. g ................................... 7 .......... ~; .......................................... ;~' ............. '~"~ ................... 9. Size of lot: Front ..... .~.~..~...~.. ..................... Rear .......~.!..~.~.m..0..../~/. ............... Depth ......~.~..~.~...d....~- ........... ~ ... 10. uat6 eT t-urcnas6 ...../...¢....:.....~ ............... ~ame o~ rormur uw,ur ...... a ................... ,. .............................................. 11. ;Zone or use district in which premises are situated ....... .~.~. ....................................... .....-.-.~.. .................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ............................................................ 13. Will lot be regraded ................................. Will excess fill be removed fromgremises:,[ ] Yes [ ] No 14, Name of Owner of premises ............. ,~x.. ............................................... .~ ............... ,.....; ................... .............. /./z (Add re~s) (~[3one No.) Name of Architect ...................................................................... i~'"~;ia~s. ................................... i~'~"~'~:iv~ ............... Name of Contractor .............. ¢.L. .................. ~.~j';' f'dres .................................... '~"~'" ~'~'~J;IPh ................. ( s) ( .) 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 indicate wheth- er interior or corner lot. STATEOFNEWYORK, -~ ~ . ) COUNI'Y OF .................... ~...v..~...'~, .(.. ,~, ' ........... )SS' .................................. ,~. ................................................................ being duty sworn, deposes and says that he is the applicant above namad. [Name of individual signing contract) He is the ................ 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 file this application; that all statements contained in this application are true to the ~EITe~f'lbi~q~ledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. N~f~ry Pubhc. $*ut, o~ New Vor~ No. 52-034,t963 Su olk Count ,~ Ha'., nf J (.,/( ~ Comm,ss,o~ Lxp,tO.jgMar~.~0' 19n~.~ j ~ Notary Publi~~-<...L~..~...... .... ~--~ County ............................................................... (// (Sign[trite of applicant)