The URL can be used to link to this page

Home My WebLink About6487-z ~'0~,~ NO. ~ 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? 6487 Z Permission is hereby granted to: ........ ~az~o'"A'~'--T~g'Z~a' ................................. .......... .~ont, a~k.. &v..e ........................................... .................. F-~.Shel'~ ;. X.st~ .......................... to .e~,e~t.. and..~tz~..s,...~.. J~.t,..hi ~h.. eb._~ in.. l~ nk.. ~en~ e... ~XL. ~JL~.~.. ~.. ~.e.~.r. ..... ~e~.~.., ~ t n,, .................................................. ,, ...................... : ................................................. at premises located at .......~.~..~3~-.~l~!~-..J~l[e .............................................................................. ..................................................... 3~J~hA~..I~la:l~ ....... ~i,~ ........................................................ pursuant to application doted .................. L.A~]~.~......~IO ........ L..., 19..~., and approved by the Building Inspector. Fee $"~¥C}0 .......... Building Inspector Approved ........................................ , FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. em, ..... Dmsapproved a/c ............................... : .................... ~,. ...... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Th~s apphcat~on must be completely filled In by typewriter or m ink and submitted m tnphcate to the Budding Inspector, w~t 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, relationship to adjoining premises or pubhc streets or areas, ar giving a detaded description of layout of property must be drawn on d~agram which is part of th~s apphcat~on. c. The work covered by th~s apphcat~on may not be commenced before ~ssuance of Budding Permit, d. Upon approval of this apphcatlon, the Budding Inspector wdl ~ssue a Budding Permit to the applicant Such permit,shall be kept c the premises available for mspectfon throughout the work e. No building shall be occupied or used in whole or m part for anv purpose whatever until a Certificate of Occupancy shall have be- granted by thE! Budding Inspector, APPLICATION IS HEREBY MADE to the Budding Department for the issuance of a Budding Permit pursuant to the Budding Zo[ Ordinance of the Town of Southo{d, Suffolk Countv, New York, and other applicable Laws, Ordinances or Regulatlons, for the construction buildings, additions or alterations, or for removal or demolition, as herren described. The apphcant agrees to comply w~th all apphcable law ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for n~,e~ry inspection .~..~.~ ~ g r~ f~ .t.,~.~ .i~p .~ ~.~ ~i..o.r~ )'~ (2 (Address of apphcant) O~390 State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build: Name of owner of premises ..~O..Ji.~..~O~:,~;[a, ........................................................................................................ If applicant is a corporate, signature of duiV authorized officer. ~Name and title of corporate officer) Budder's License No .......................................................... Plumber's License No ......................................................... Electrmian's License No ..................................................... Other Trade's License No ................................................... 1, Location of land on which proposed work will be done. Map No ............................................... Lot No ........................ Street and Number ....... ~[/.~..,~g~'~;..~,~.f~.~,.....~.~.$~f~,~.~....T,~"31~.~...~.~..~.~.O ........................................ Municipality 2. State existing use and occupancy of premiss and intended use and occupancy of propo~d con~ucti~: a. Existing use and occupancy...~e~ ............................................................................................................ b. Inlended use and occupancy ......... 3. Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration ............... Repair . ........................ Removal ......................... Demolition ........................ Other Work "~Fe~t~.: .......... ~uescrtpT~onl 4. Estimated Cost ...~.. .......................................... Fee $...~,0~ ................................................................................ (to be paid on flhng th~s application) 5. If dwelling, number of dwelling units ..... .0 ......... Number of dwelling units on each floor ......................................... If garage, number of cars ............................................................................................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................................... 7. Dimensions of existing structures, if any: Front .....................Rear ........................... Depth ................................... Height ........................................................... Number of Stories ............................................................................. Dimensions of same structure with alterations or additions: Front .......................... Rear ........................................ Depth ............................................. Height .................................... ~ .... Number of Stories ....................................... 8. Dimensions of entire new construction: Front ......................... Rear ............................ Depth ................................ Height ................................................. Number of Stories ....................................................................................... 9. Size of lot: Front ...... 6~i'~ .................... Rear ........ ff~9'~ ...................... Depth ..29~8...../.....L~8.~,~$(~.. 10. Date of Purchase ..................................... Name of Former Owner ....... ]~&S~.:~a ................................................... 11. Zone or use district in which premises are situated .... !!A,.~...=~s,,a,g~,&e~ ............................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ............ t~(~ ......................................... 13. Will lot be regraded ..... ~ ..................... Will excess fill be removed from premises: [ ] Yes iX] No 14. Name of Owner of premises .... ~a.t~.:J..o..~,...~.o~l..:[e~ ............... i~,~res~s e.~$..~sl~d.. ......................................... (Phone No.) Name of Architect .................................................................................................................................................... (Address) {Phone No.) Name of Contractor ........ ~.~,~I,~ ................................................................................................................................ (Address) (Phone No.) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fro property lines. Give street and block number or description according to deed, and show street names and indicate whet er interior or corner lot. See attached pl~ STATE OF NEW YORK, ) COUNTY OF ........ ............... C~Q..A~. T.ogl:La ........................ being duly sworn, deposes and says that he ,s the apphcant above nam- (Name of tnd~vtdual signing contract) He Is the .......................... ~1~-...0,~.. t~I~tl~I-~-~Le~t .......................... (Contractor, agent, corporate officer, et~ ) ..................................................... of sa~d owne~ or owners, and ~s duly authorized to ~rform or have performed the sa~d work and to make and fde th~s apphcat~on; tha, statements contained m th~s apphcat~on are true to the best of h~s knowledge and behef; and that the work wdl be ~rformed m the mar set forth m the apphcatmn hied there~ & AHI~ ~ Notary Pubhc~.~..~.~,~ .... ~~ County ..~. ..... [ ...................... . .............................. (&~ature of app mant) , . ~ FORM NO. 1 ,.. . '"Ii '. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN .cLERK'S OFFICE SOUTH OLD, N. Y. "'-"u .... I.....,<.~. Examined ......~......I..7......, '1 'I ........................................, 73 19........ 19..?~. Pemit No. i/1..f...7...~....... (r~r( ;t/;; ;Lc4<~ Application No. ..f.Y.rf:..l............. Approved Disapproved ale .................................................... ..............................................................................t..........................~........ ......................b................................................................ (Building Inspect APPLICATION FOR BUILDING PERMIT Date ..................ApJ:U.....1.Q........., 19..7.3...... 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. 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 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 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 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 comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in build"ngs for necessary inspections. x Q.~.f)...~............ ............................... (Signature of applicant, or na ,if a corporation) Mp.ntauk...Av.e...,...F.isher.s...Is.~nd.....N~.Y. . (Address of applicant) 06390 State whether applicant Is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................................. .9.\om..~.r............................................................................................................................. ...... Name of owner of premises ..c.anio...A......'!og.lia............................................................................................................ If applicant is a corporate, signature of duly authorized officer. ................................................................................................... (Name and title of corporate officer) Builder's License No. ......................................................... Plumber's License No. ........................................................ Electrician's License No. .................................................... Other Trade's License No. .................................................. XXX 1. Location of land on which proposed work will be done. Map No...............................................Lot No. .......~.......... Street and Nu mber ......N 1$... J::!QJ)..t.~W!;.. t. v.~ .f..... F.i. she r.s... I.s.la.ud.,.. .N...Y.... .06~ \)0........................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..~w.~lli.n.g ....................... .... .... ....... .............. ........................................................... b. Intended use and occupancy .......l1f1.mil...w;i..t.h...IJ.ddUi.Qnal..!t.t::t...h1.gh...c.oa.tad...clla;ba..;I,.:!,nk....t:e-noe .. ..: 3. Nature of _ork '1':heck which applicable): New Building ....................... Addition ..................... Alteration............... Repair ......................... Removal......................... Demolition ........................ Other Work ...Q.,.k~f.'?~9.'?............ ( Description) 4. Esti mated Cost ..~.......................................... Fee . i.. Jl5.., ,9.9................................................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ......9......... Number of dwelling units on each floor ......................................... I f garage, nu moor of cars .................................................................................................................................... ........ 6. If business. commercial or mixed occuoancy, specify nature and extent of each type of use ..................................... 7. Dimensions of existing structures, if any: Front ..................... Rear ........................... Depth ................................... Height ........................................................... Nu mber 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 ................. ................................ Nu mber of Stories .................. ........ ...................... ..... .................................... 9. Size of lot: Front .......6:1i...87.................... Rear .........:1I!t.9..6...................... Depth ..2.9.5'...e.....L...2R.e...:t.1.Q.,3... 10. Date of Purchase ..................................... Name of Former Owner ........~.9.al\:.:j,tl~.................................................... d. . . h' h . 't t d "A" res-a"'ric 11. Zone or use Istnct In w IC premises are Sl ua e ..........................<>........~................................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ............J.l0........................................... 13. Will lot be regraded _...>>.0..................... Will excess fill be removed from premises: [ ] Yes [XI No 14. Name of Owner of premises .....Oani.Q..A.,...!Qg.l1a..................f.i~h~r.~..);.~J~l!~........................................... (Address) (Phone No.) Name of Arch itect ..................................................................................................................................................... (Address) (Phone No.) Na me of Co ntractor ........ .~.f!:T!!.~.................................................................................................................................. (Address) (Phone No.) 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. See attached plan STATE OF NEW YORK. ) COUNTY OF ...............s.W,'f.9.;lJ.\:....................) ss ...........................G~g;i,.<:>...fl:.~...!9.g.+..~~....................................... being duly sworn, deposes and says that he is the applicant above named. (Name of individual signingcontract) He is the ........................ ...... '" ............9.wne.;r;....Qf..:P.:+.~.!!lJ.~~.~...................................................................................................................... (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 be;t~ff his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. LUCY ~'t ~:Ir~f New YOlk J J- Notary Pu blL :I tJ. '" ,.... ~ - ! 'n No ~ ~-0028880 ...... .............J.K.........day of ...~.:'>t!thli!!~.~..:;:..';;;=.g~~lW'17.~......c.. Q . .......t;.lII"': Telm explIe& ,Y Notary PubliC. ~.~.~.,.t.J.,~............S1~ County........ .~.._.....isig;,~;~;~ 0