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Home My WebLink About6032-zTOWN OF $OUTHOLD BUILDING DEPARTMENT TOW~ CLERK'S OFFIGE SOUTHOLD, N.. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 6032 Z Date ............. ~ ......................................... , 19....L.. Permission is hereby granted to: ...... Peeor,.ic .......... N-,.~.~ ..................... : ................ at premises located at ........ ~./~...~.~.t,~..[(~.~.)...~O.~,~, ......... i ....... .......... ; ..................................... ................................................... · ~oeem~.. ............. ~. ............ L: ..................................................... ;..,~9 ....... ~nd approved by the pursuant to application dated ~'7:'"'; .......................... ~ ....... ~ ...... Building Inspector. ~: Fee $.. J.-.~.~,OD ......... / .......... !.:;\~,,:.?..¢:.....: ......... ~.,..~;;.:...~ ..................... ' Bud ng Inspector 1~ ~01~ NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENI~ TOWN CLERK'S OFFICE~ SOUTHOLD, N. Y. Disapproved a/c ................................................................................... APPLICATION FOR BUILDING PERMIT "~ Date .................... r~... '.~....~.: .............. , 19.?..~.cb INSTRUCTIONS a, This application must be completely filled In by typewriter or in ink and iubmitted in triplicate to the Building Inspector, 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Pict 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 which is part of this application. c. The work covered by this apphcation may not be commenced before issuance ~f Budding Permit. d. Upon approval of this application, the Building Inspector will issue a Buildin~ Permit to the applicant. Such permit shall be kept on~- the premises avadable for inspection throughout the work. e. No building shall be occupied or used m whole or in part for any purpose whatever until a Certificate of Occupancy shall have been~L~ granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building 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 apphcabJe Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described, ;The app icant agrees to comply w th all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections, /(Address of applicant) State whether applicant 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 ofhcer) 1. Location of land on which proposed work will be done. Map No.: ....... ~/?.~ .......... ., ....................... Lot No ............. Street and Number ..c~.~-.~.~...~?.?~,~.~,....~,'~~. .............................................. / Municipality 2. State existing use and occupancy of premises and intended use and occgpancy of proposed construction: a. Ex,st,ng use and occupancy ... ,~,~z.~/.......~....~,,g~..' ' ~ ........................................................... b. Intended use and occupancy ..~/~,-z~,-~.~'~,~.~......~..'.../~,(~,....~:' ' ............................................. 3. Nature of work (check which applicable): New Building ....................... Addition ..................... Alterations, ............ > Repair ............. ,...,, ....... Bemoval ......................... Demolition ........................ Other Wot . . 4. Estimated Cost ¢../ ..~.,.~... ............................. Fee ............................................................ (to be paid on filing this applieat,onl~ ........ I'~'e'~'c':l'P'::'°'n'! .......... 5. If dwellinfl, number of dwelling units ................. Number of dwellin§ units on each floor ......................................... if garage, number of cars ............................................................................................................................................ 6. If business, commercial or mixed occupancy, specify natur~ and extent of each type of use ..................................... 7. Dimensions of existing structures, if an¥: Front .....................Rear ........................... Depth ................................... Height ........................................................... Number of Stories ............................................................................ .' Dimensions of same structure with alterations or additions: Front .......................... Bear ......................................... Depth ............................................. Height ......................................... Number of Stories ........................................ 8. Dimensions of entire new construction: Front ......................... Rear ............................ Depth ................................. Height ................................................. Number of Stories ......................................................................................... 0. Size of lot: Front ...................................... Rear .......................................... Depth .................................................. 10. Date of Purchase ..................................... 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. Will lot be regraded ................................... Will excess fill be removed from premis~: [ ] Yes [ ] No .// (Address) (Phone No.) Name of Architect ..................................................................................................................................................... (Address) (Phone No.) Name of Contractor ................................................................................................................................................... (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. STATE OF NEW YOR~"~ /7~, ,~- ) ...... ................. I ........ ~.,_.~.~_~_~...~--~.~ .......................... ............ being duly sworn, deposes and says that he is the applicant above named, {Contractor, agent, corporate officer, etc.) o~ 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. MADELYN M. BAKER ' 9 .~..~ No. s2.0138300 - Suffolk O ........................ .....4,y of .....>/., .................................. Notary Public, ..6..~..~.....~~unty ................... ~~ ............................... FOI~M NO. 1 TO~VN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ...... Disapproved a/c .............~.~~.~..~.~,ZZp.~.... APPLICATION FOR BUILDING PERMIT Date INSTRUCTIONS a. This application must be completely filled in by typewriter or in mk and submitted in triplicate to the Building Inspector, with 3 sets of pJans, accurate plot plan to scale· Fee according to schedule· b. Plot plan showing location of lot and of buildings on premises, relationship to adjoimng premises or public streets or areas, and giving a detailed description of layout of property must be drawn on diagram wh~bh is part of this application. c. The work covered by this application may not be commenced before issuance qf Budding Permit. d. Upon approval of this apphcat~on, the Building Inspector will issue a Building Permit to the applicant, Such permit shall be kept on the premises avagable for inspection throughout the work. i e. No building shall be occupied or used m whole or in part for any purpose w~atever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the Issuanc~ 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 here~n described. The applicant agrees to comply with all applicable laws~ ordinances, building code, housing code, and regu lat~ons, and to admit authorized inspectbrs on premises and in buildings for necessary inspections·, (Signature of applicant, or name, ~f a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contrac{or, 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.: ....... ; ............................................. Lot No ............. Street and Number ............................................................... ~ ....................................................................... : Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ........................~ ............ ~.; .......... J....'...,~.i ....... ; ............................................................. b. Intended use and occupancy .......................................................... ; .......... ; ............................................................ 3. Nature of work (check wh'ch apphcable):' New Building ....................... Addition ................. .;.. ~'Al?rati°n"r:'"':~ ,. ~ F;~, ...... Repmr ........................ Remora .... DemohBon ........................ Other ~dr~.....; ............ ,' Descr pt on 4. Estimated Cos . '..~.~ ........ ............................................................................................................................ 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. 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 ...................................... Rear .......................................... Depth ........................................... 10. ' Date of Purchase ..................................... 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. Will lot be regraded ................................. Will excess fill be removed from premise~: [ ] Yes [ ] No 14. Name of Owner of premises;,.', . ...... ,. . ., ,' ...,~; .................... . . . ,.~ ......... ; ....... ,,L,'......,....; ..................... . (Address) (Phone No.) Name of Architect ..................................................................................................................................................... (Address) (Phone No.) Name of Contractor ................................................................................................................................................... (Address) (Phone No. PLOT DIAGRAM Eocate 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 K, COUNTY OF ......... ........................ ~.i~ ............. ~..,~ ............ ,~ ........................................... being duty sworn, deposes and says that he is the applicant above named. ~ ' .... ' "~"" '~m~o~'~ndiVidual Sl'gn/ng contract) 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. , IdADEtYN M. BAKSE ................... ;LZ~....~ay of ....2.~ ............. q~ ........................ 19 ............. ~,~,,~h.~,~ ~. ~ .............................................. ~amm of app ~cant)