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Home My WebLink About6562-z " ~-2~' 7 ~ r~ - o~~ - · ow~ o~ ~u~.o~ ~ _ ~ , ~ ~ r ~_. BUILDING DEPARTMENT~, ~ ~~ TOWN CLERK'S OFFICE ~ ~ ~/ ~amined 19~. Application No.~.~ ............. ~pr~ed 19.~ Pemit No..~..~...~.~ .... ~ ~ ................ .......................................... .......... '~ .................. ~_~_.~~ ................ ~, ............... ~, ~ o ~ I~ ( ~Buading In~tor) ,-, / ~t ~ r APPLI¢ATION FOR BUILDING PE~IT Date ~Z 10 19.~ INSTRU~IONS , , a. This appli~fion must ~ completely filled in by ty~wri~er, or in ink and submitted in triplicate to ~he Building Inspector, wit~ 3 ~ts of plans, a~urate plot plan to scale. Fee a~rding to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship ~o adjoining premises or public streets or areas, and giving a detailed description of layout of pro~rty must ~ drawn on diagram which is pa~ of this appli~fion. c. The work ~vered by this application may no~ ~ commen~d ~fore issuance of Building Permit. d. U~n approval of this appli~fion, the Building Ins~ctor will issue a Building Permit to the applicant. Such ~rmit shall be kept o the premiss available for Jns~ction throughout the work. e, No building shall ~ occupied or u~d in whole or in part for any purpo~ whatever until a Cerfifi~te of Occupan~ shall have be~ gsan~d by the Building Ins~ctor. I 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, Suffotk 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 buildings for necessary inspections.--. (Signature of applicant, or name, if a corporation) Orient N .Y. (Address of applicant) State whether applicant is owner, lessee, agent, amhitact, engineer, general contractor, electrician, plumber or builder. .......................................................... ~.e. ~....-:...~ .~;I,.~,~.~.~: ................................................................................................... Name of owner of premises ....~.~..~..-.....~.~;~..z..*.....~.P,D...~...o.~.t;;~'.~[~I. ....................................................................................... 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 ................................................... 1. Location of land on which proposed work will be done. Map No .................... ~ ..................... Lot No ..... ~ ............... Street and Number ................. ~../..~....V...:J:.]r..]...a:~..e...~.a: .............. .0...~..1..e...~..~. .................. 2_: ................................................... ' Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ............. ~fl~'~g .................................................................................................... b. Intended use and occupancy .................. ~e...l~l~'~-..~f.~..s.~oclrarle...~p~..£ezlc~-..fi~l:t..,~L~,~..-/,~'ll~ .... l~t;re of work (check which applicable): New .Buildin~q ....................... Addition ..................... Alteration ............... Repair ......................... Removal ......................... Demolition ................ . ........ Other Work ..~..e..~...o..e. ................. / (Description) 4 · t Estimated Cost ............................................... Fee ..... Z~.~00 ........................... f~ (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 .............................................................. 6. If business· commercial or mixed occupancy, specify nature and extent of each type of use ..................................... 7. .D!menslons of exmt~ng structures, if any: Front , , Rear ........ Depth .................... ,Heig*nt ~ · ~ ~ · ....................~ ..................................... Number of Stories ............................................................................. Dimensior~s of same st. ru. cture With alterations or additions: Front .......................... Rear ......................................... Depth ............................... ;. ........ L'L 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 "Au dist premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........:I3,Q ............................................... 13. Will lot be regraded ........ ..~..o.. .................... Will excess fill be removed from premises: [ ] Yes [ ] No 14. Name of Owner of premises ...$A1;"..,~,:~.,...~..~.~$.I;;.E{~L~I0, .............................................................................. (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 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 Suffo~ t ............................................... ~O.]}.l;...,~.~q-...~.Q~.~'.~,~0, ............ being duly sworn, deposes and says that he is the applicant above named. (Name of individual signing contract} He is the .............................................. .~..~,.1.~.~.~'. ............................................................................................................................................... (Contractor, agent, corporate officer, etc. J 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. ............................ · 1...O......day of ......................... ***~...~. ................. 19 ~..3. ......... FOR~ NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6562 Z Permission is hereby granted to: ---ll~tt~-,e~.-~];ta ~,- Yez~..~os-tz~_ ~ ....... ~o ..~.ect..and..~atz~t~i~..a...6£t.~toekafl~..t.ype..i'enee..on...sti~..1.~te ............. ~t premises located at .......... 14/~...~.i~L~e..~aJ:a~ ........................................................................... ..................................................... O~e.~t ........... ~l..~Z... ....................................................................... pursuant to application dated ........................... ~ ........ .1.0 ........ 19.*~.., ond approved by the Building Inspector. Budding I nspe]/t/or FOP,~I NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE $OUTHOLD, N. Y. APPLICATION FOR BUILDING PERMIT Date ................ ~it.~ ......... .1. D .......... , 19~'~ .... INSTRUCTIONS a. Th~s apphcatlon must be completely filled m by typewriter or ~n ~nk and submitted ~n tr~phcate to the Budding Inspector, w 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 pubhc streets or areas, · gwmg a detaded description of layout of property must be drawn on d~agram which ~s part of th~s apphcation. c. The work covered by thts apphcat~on may not be commenced before ~ssuance of Building Permit. d. Upon approval of th~s apphcatron, the Budding Inspector wdl issue a Budding Permit to the apphcant. Such permit,shall be kept the premises avadable for ~nspect~on throughout the work e. No budding shall be occupied or used m whole or m part for any purpose whatever untd a Cert~fmate of Occupancy shall have b granted by the Building Inspector APPLICATION IS HEREBY MADE to the Budding Department for the ~ssuance of a Budding Permit pursuant to the Building Z, Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances or Regulations, for the constructlo buddings, additions or alterations, or for removal or demoht~on, as herein described The apphcant agrees to comply w~th all apphcable la ordinances, budding code, housing code, and regulations, and to admit authorized tnspectors on premises and m buildings for necessary mspect~o (S~gnature of apphcant, or name, ~f a corporation) · O~lent ...H.~f. .... (Address of apphcant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build .......................................................... Owme~*..~-..Z)ull~e~ ................................................................................................ Name of owner of premises ..l~s.~,...~l;t~,,...V~n..N~st,z,&:l~ .................................................................................... If applicant is a corporate, signature of duly authorized officer. ~Name and t~tle of corporate officer) Builder'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 .................... 'XX ..................... Lot No ....'XX ............. Street and Number ................. W~.~...V.I._'I__t_~E~.._T.,~_~ .............. r~Z,.:Le31t ......................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ............. ~.-vce13,~D.~ .................................................................................................. b. Intended use and occupancy .................. sa.~e...~;[.~,h..~..s.t~ke,~..~.~pe...f.e~.-o~..$.i~e...~.. 3. Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration .............. Repair ......................... Removal ......................... Demolition ........................ Other Work ...[~e~e .......... ; ......... ~ uescr~pt~on~ 4. Estimated Cost ............................................... Fee .... ................................. 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 occuoancv, 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 ~n which premises are situated "JUt ~LJ. Bt; 12. Does proposed construction violate any zoning law, ordinance or regulation: ....... ~. .............................................. 13. Will lot be regraded ...... ~,.O. .................... Will excess fill be removed from premises: [ ] Yes [ ] No 14. Name of Owner of premises ..~.e...~,~;.~...~3...~..~.~.~;3,~ ............................................................................. {Address) (Phone No.) Nam~ of Architect .................................................................................................................................................... {Address) (Phone No.I Name of Contractor .................................................................................................................................................. {Address) (Phone No.) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions frol property lines, Give street and block number or description according to deed, and show street names and indicate whetl er interior or corner lot, .. ?. ............... COUNTY OF .......... .~.' ,t~..;~O . .................................... J~'~Ob.~...~.~..~.O~..~..~.?-.~.. ......... being duly sworn, deposes and says that he ,s the apphcant above name [Name of tndzvtdual signing contract) He ,s the ...................... .~..t~.~.d:..e,.?. ..................................................... (Contractor, agent, corporate ofJ~cer, etc ) of smd owner or owners, and ~s du{y authorized to perform or have performed the said work and to make and hie this apphcat~on; that statements contained ~n th~s apphcat~on are true to the best of h~s knowledge and behef, and that the work wdl be performed m the man~ set forth ~n the apphcat~on fded therewith .............. 1..0.....day of ............. .............. ....... Notary Pubhc ............................................... County (Stgnature of applicant)