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HomeMy WebLinkAbout7083-z I~OB, M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, No Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P'REMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 7083 Z Permission is hereby granted to: ...... ~..z.,. .............. /....'~/.'.: ................. ¢~...~.......~.~,~ ~.~....,f'.~ ~..../.2..)~.<.<.u.. ....... ~.~... ......... ~..~..~.~..~./...~.........-:...~.....~.. ............. .~f.~ ........................... ,~:......~.. ~/.~..~ ~... ~ ~.Y~o. - at pr, m~,~ ~o,:ated ot ...~.T~.'[...~.~,0......~..~..~..<~ .............. -~-.~...: ....................................... Building Inspector. pursuant to application dated .~'~e~../...-~...~.~..(-/...,~'../..'..~..y ....... ./.../. ......... , a roved by the ouilatng Inspector Approved ........................................ , TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 19 ........ Permit No ......... Application No.. ' Disapproved o/c ......... ~ ................................................ (Building ~nspectorJ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter o~. Jn ink and submitted in triplicate to t~e 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 o~ ~ areas, and giving a detailed description of layout ofproperty must be drawn on the 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 Occupa~: shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pu=uant 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 bulldlngs for ~.[sj~.~gi.,r-~l ~ Southo~d Historical oolety (Signature of applicant-, or name, if a corporation) ..~. in Roa,~ ~..n..d......M.a...p. ls..~e (Address of appficant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........................ ~me~,. ........................................................................................................ L ..................................................... Name of owner of premises ....~...o.~.o..~...fi.~..a.~..o..~.~.?.?..~ ...~...o.?.~...e..~.~. ................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No.T'e° ~msnes]ct Plumber's License No. ~TohD. Walt;ez, s Electrician's License No. ?e~ez, B~o o~r~o Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: ........................................Lot No ......................... Street and Number 8ou~ho].cl Histoz'ioal Societ.~. ~.~..o.p.e..z....t~.' ...l~..in Road & Maple Lane Municlpplity State existing use and occupancy of premises and intended use and occupancy of proposed comtruction: Exisiting use and occupancy Museum Intended use and occupancy ...... ~lRII.e.tRl~..l~.IR~.~I,~. t;o house car~i,.a~es Nature of work (check which applicable); New Building .................. Addition .................. Alteration .................. z Repair ....; ............. Removal .................. Demolition .................... Other Work ...~..~.-~T~..TRg.~.~.~,..~.g~..,~,....~ 4. Estimated Cost ............ '. ........................................ Fee ~?~.d~...e~...~....~.... ......................................................... (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 ......... C&~'zt:L~4~..t:u~e-,t;~L~-..~ed,~--~...~o~..~e....~..~a~z)i~ul~48 .............................. If business, commercial or mixed occupancy, speedily nature and extent of each type of Use ............................ Dimensions of existing structures, if any: Front ...... ~ ................ ; Rear ........~;. ..................... Depth ..~.~ .............. Heigh~ ................. : ...... Number of Stories .......... .~.~T.~ ............................................................................................... Dimensions of same structure with alterations or additions: Front ~.o...b~..~e.~G...i~8..,~,aRear ............................ 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 ...... G~,~..~,,.'i.c~'~.3 ............................ Name of Former Owner ...~.~..~.~....Dg.....V~..~. ......................... 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. V~ill lot be regraded............................n° Will excess fill be removed from premises: ( ) Yes~ (~) No 14. Name of Owner of premises .~.~,~'O~L~..]J-t-&~O~L:L.~..°. ~'~c~;e~s.-N~.-.Z~.-~..~..~.~. P 76 -55oo hone No ........., ............. Name of Architect .............................................................. Address .......... , ..................... Phone No~ ...................... Name of Contractor T'eo ~w~ugrses]~J. Address ..?...~..~...~..~..~...~......]~...t.... Phone 765- 568 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 · whether interior or corner lot. STATE OF NE~/YORI~. ~ ¢ c COUNTY Of ..3..~.~.~..g,,1,.11: ............... ~'"'"" George D. Wagone~ ................................................................ , ................................ being duly sworn, deposes and says that he is the oppticani (Name of individual signing contracf) above named. He is the .......... .O...o.~.g..o.~.~..t~.~....9.~:J,.~.~. ............................................................................................................................. (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 contoined 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. Sworn to b~me me this ......... Notary Public~ .~'.... ;~nty .......... ,Z.....~..~..~ ....;.~. .......... .T..',~Z.;.Y.....~Z. ........................ ~ ignature of applicant) JUDITH T. BOKEN r~ig Notmy Public, State of New York No. 52 -0344963 Suffolk County ~mrnis~ion Explree March 30~ I',IAP OF " ~ ' ,~4!STORJ©~,L'~OC !ET"--,,' 9~..,~OUTH, O~,~.¥ :