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Home My WebLink About6536-z 1~0~ NO. :~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTitOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6536 Z Permission is hereby granted to: · .-E~wa-~d.-.A.....E*o£-l*e ~' ..................................... .......... ~.l;.~,.~.u~k ............................................ to ~;eo~..a~t..am.t~.t~./~..e..~nee ..... ~4~£.~.~-.on..~..P~ ............................................... a[ premises located at ....... O3,-e..,Tt~.e.../~e.~e .................................................................................... ....................................................... ~t,~ua~ ...... ~,*¥, ................................................................... pursuont ~o application dated ........................]~......~ ................. , ]0.~.~..., and approved by tl'~e Building Inspector. Fee $.'J, ~'.J, O0. ........... Building Inspector lOCAl"IONS NOTE BsMONUMENT .Ews,o~s YOUNG & YOUNG AUG0$1,1gTE 400 OSTRANDER AVENUE, RIVEKHEAD, NOV. 14~1972 ALDEN W. YOUNG ~ MATTITUCK -~~ A.~ICAN TITLE tNSU~CE CO. s u~o ~ co.. ,. ~. FORM NO. 1 Examined Approved TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD~ N. ¥. Disapproved a/c ............................................................................................ (Building I nsp~') APPLICATION FOR BUILDING PERMIT ............. ..... ........ INSTRUCTION$ a. This apphcatlon must be completely filled in by typewriter or in ink and submitted in tnphcate to the Budding Inspector, v 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, giving a detailed description of layout of property must be drawn on d~agram which is part of th~s application c. The work covered by th~s applmat~on may not be commenced before ~ssuance of Building Permit d. Upon approval of th~s application, the Building Inspector will issue a Building Permit to the applicant Such permit,shall be kept the premises available for inspection throughout the work e, No bu~dmg shell be occupmd or used m whole or m part for any purpose whatever until a Certificate of Occupancy shall have b granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Budding Department for the ~ssuance of a Building Permit pursuant to the Building Z, Ordinance of the Town of Southold, Suffotk County, New York, and other apphcable Laws, Ordinances or Regulations, for the constructio~ buildings, additions or alterations, or for removal or demoht~on, as herein described The apphcant agrees to comply w~th all apphcabie ia ordinances, b~dding code, housing code, and regulations, and to admtt authortzed inspectors on premtses end ~n buildings for necessary ~nspect~o (Signature of applmanL orrn/am~/~f a corporation) ' "' ....... (Address of apphcant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build ...................................................... ......... ., .............................................................................................. & Name of owner of premises ...... ~.~.,.,.L~,...~.,.,~.;/~,~ ...... ~L~ ..... ~ .~..~. ,~'~,,....~-.~'~..,;; ............. ~'. .................................. If applicant is a corporate, signature 6f duly au'thorized officer. IName and title of corporate officer) Builder's License No .......................................................... Plumber's License No ......................................................... ElecLric~an'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 .............. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisdng use and occupancy ........ ' '~"/2'~[""'"'~"'~"~" '~'"'~"'" ~'J~!'~-~'~"~"i'"~'"~'~~-r ~ ~,~- ~ ..... -" ............................ b. Intended use and occupancy ...................................... .~.~..'...~-~....~..~...~.........~.~ .............................. 3,~ '~a~'dre of work (check which applicable): New Building ....................... Addition ........ ~ .......... Alteration ............... Repair. ........................ Removal ......................... Demolition ........................ Other Wo~ k~,.,r:, .~.,~,~,~,,;,~.',~:.~. :..,~;: (Description) 4. Estimated Cost ....~.....Z~.~...~.~ ........................ Fee ................................................................................................. (to be prod on hhng th~s apphcat~on) 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 ~ot be regraded ................................ Will excess fill be removed from premises: [ ] Yes [ ] No 14. Name of Owner of premises ..................................................................................................................................... (Address) (Phone No.) Name of Architect .................................................................................................................................................... (Address) (Phone No.) Name of Contractor ................................................................................................................................................. (Address) (Phone No ) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fr¢ property lines. Give street and block number or description accordi to deed, and show street names and indicate whe; er interior or corner lot. ,0 STATE OF NEW YORK,, ) SS COUNTY OF .....~J .~.~\?,<, .......... ) ............ ...... ['Name o.f md~vtdual szgnmg contract) set forth ~n the apphcat~on hied therewith TERRI LEE ~ .........~.--- oay o~ ....... ~.:_w~:~ .~,I~ ,~, ~ ....... ~9~-~ ..... Notary , , '. . . . ~ County (Stgnature of apphcant} He ,s the ......... .~.k...~..~.~.~.. .................................................... (Contractor, agent, corporate officer, etc ) of sa~d owner or owners, and ~s duly authorized to perform or have performed the said work and to make and fde th~s apphcation, tha ~tatements contained m th~s apphcat~on are true to the best of h~s knowledge and behef, and that the work wdl be performed m the ma~ bmng duly sworn, deposes and says that he ~s the apphcant above nam