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Home My WebLink About6406-z FOF~ 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? 6406 Z Date .................... ~ r.e,~',h .....1.~ .............. , 19.~J.. Permission is hereby gronted to: ~i...q.....Lo.~;~;..:::~.~... ~.c......~/..~....~..~.e.~ b,~ ..~ ~sk ! ........ .~;~.~.'LI ~c~ ................................................. to ~.e..;::;..c..~`..~`~f~.~'~;~1r~.~*`~::~..7.~.~c~.~..h~ ............................................. at premises located at .....L..o...f,...,~..1...~..~ .......... .~.q.~,~f.Q.~:~...~.C.~.~.~j ..................................................... .......................................... ~l~.~no~L..~.=lue .............. ~o~th~l~ ..................................................... pursuant to application dated ............................ ~.~'......1..LF. .......... , I~.,~...., and opproved by tlne Building Inspector. Building Inspector Approved ........................................ , FOI~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT~ TOW~4 CLERK'S OFFICE SOUTHOLD, N. Y. APPLICATION FOR BUILDING PERMIT Date ~z'eh '1~. .. , 1973 INSTRUCTIONS a. Th~s application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, 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, a~'d 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 of Building Permit. / d. Upon approval of this application, the Building 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 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 apphcant 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. ~.~r~n..F~...~e. noa,..C.o~p ............................... (Signature of applicant, or name, if a corporation) S:ound ~ve. Mattituck (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, 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..~..~..&....~2,... ....................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................................. , .................................................................................................. b. Intended use and occupancy ................................ ~.,.~ .............................................................. 3. "Nature of work (check which applicable): New Building ....................... Addition ..................... A teration'. .......... Repair'. ........................ Removal ................... ; ..... Demolition ........................ Other Work ..~...o..n..9.~....,~'. ............... (Description) 4. Estimated Cost ...[bQO4.Q0 .............................. Fee ..J,~.~.Q.0, ................................................................................... (to be paid on fi~ing this application) 5. If dwelling, number of dwelling units .................Number of dweMing 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 .....1..0...0. ........................... Rear ...J:..]:..~. ................................. Depth J.2;~ & 126 Height .................................................... Number of Stories ...................................................................................... 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: ...~O .................................................... 13. Will lot be regraded ..................................... Will excess fill be removed from premises: [ ] Yes [ ] No 14. Name of Owner of premises l$.'r, etalaa.rl..&...~.ala. Jo.a..R1J.~.~lt~:L~.~l~l~.QQ..~.,...~.~.~ ....................... (Address) (Phene 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 ....~l~,~':~'JJ~. ................... ....... ~I1~1,O. IIIO.~1...~....~,~[~,]~. ................................................... being duly sworn, deposes and says that he is the applicant above named. (Name of individual si~h~g 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 ~ile this a~plication; that all statements contained in this application are true~ thett~Io~, t~t~l~Qowledge and belief and that the work will be performed in the manner- set forth in the application filed therew,th. No, 6~-034- ' ,o ot ,%~v York ............ ......................... : ........ /// / ~ .... ~ (Signature oy app~an~