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Home My WebLink About7101-z FI)BM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN C:LERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 7101 Z Date .................... MAFe~ .........Il, ........... , i 9.eii~.. Permission is hereby granted to: Roh~=.t..L...~I~at~.....A~....~ah.....Shav to .~..u-.ed4~.t,S~..e~..e~t ot~nf.. ~e-l.l. iq ............................................................... at premises located at ....fl, dlKL'ql~...C,,%'qt~l~k..J~l)4.([ ....... (,ll~..,~lkll...D.~.,.~,.~ ................................. ............................................... lJ.~.t,~.q;~dt .......... P..,.T,. ........................................................................... pursuant to application dated ................... .~.....F~....h. ......... ..~. ............. , 19...~..~., and approved by the Building Inspector. THE NEW YORK BOARD OF FIRE UNDERWRITERS I-- ~ eUREAU OF ECECTmC~,' " 85 JOHN STREET, NEW YORK. NEW YORK 10038 ' -,. A,... ~o, ~ ~.,~.,,o.~_.,,,. ~o.~ N 156555 THIS CE~IFIES THAT only the e~t~M ~u~ment ~ ~c~b~ ~ ~ int~ by t~ ~t ~ on t~ a~ ~ ~ ~ t~ ~m~s of ~ann~ 5ha., ~/~ P~Iv. ~d., e/off Ba3vte- Rd., ~00' -/o Cedar 3outAo~ ~. ~. in the fol~ing I~at~n; ~ B~ement ~ 1st FI, ~ 2nd FI. ~tion B~k OTHRR APPARATUS: R V I C OF CC, COND, EXHAUST FANS DIMMERS COPY FOR BUILDING DEPARTMEHT, LTHIS COPY OF CERTIFICATE_ M~.UST~.~NOT ~'~F.~,D~ IN ANY MANNER. TOWN OF SOUTHOLD / /eU:LDING DEP^RTMENT T~OWN CLERK'S OFFICE SOUTHOLD, N. Y. ......... ........... Examined 19 ....... [ Approved ................... ~.~......:) ............ , 19..."~....c.I Permit No. / Disapproved a/c ...... ~......~ ~ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date March ~ 197+ 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 ad oining premises or public streets areas, and giving a detai ed description of layout ofpraperty 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 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 buildings for necessary inspections. (Signature of applicant,/ei; J~am~, if a corporation) 8outhold N.Y · (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.~ ....................................................... ........................................................................................................................... Name of owner of premises l~&zl.,~. Shaw ........................................................... 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.:....]~°ire....... .............. 0.D aaa.. ....... Lot No ......................... Street and Number ...... .Co.~.e~...g~ee_~..,J:J,oacJ......(JbJir.~ ..................................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy b. Intended use and occupancy sa~e with an addition 3. Nature of work (check which applicable): New Building .................. Addition .....~ ...... Alteration .............. Repair .................. Removal .................. Demolition .................... Other Work ................................................ (Description) 4. Estimated Cost .................. ..~.'~..0...0..0...+ ......................... Fee ..... ~.e..O..0. ......................................................................... (to be paid on filing this application) §. If dwelling, number of dwelling units ...o..~...e. .................... Number of dwelling units onleach 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 a~Jditions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ........... ~. ...................... Rear ....... ~? ................... Depth ....]..LI: ............... Height .................... Number of Stories .......... Q~e, ..................................................................................................... 9. Size of lot: Front ..~..Q ................................................. Rear ........ 9.Q ............................. Depth ....... .1.2.0. ................. 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ...... !.~A!!...cl.:Ls:~ ........................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..no ................................................. 13. Will lot be regraded ....nj) ................... Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises ....]~,~g,~.....J~b,~,~. ..................Address .....J~.Q~O.[I~ ....... Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor Robert L. Hyatt In¢ Address Southold Phone No. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-b~ck 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. See'attached plan STATE OF NEW_YQI~K.. COUNTY OF ..~..~..~.~iO..'..'~:....;....:...;. Robert L. Hy. att bein duly sworn, deposes and says that he is the applicant (Name of individual signing contracf) above named. Builder &Corp officer 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 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 before me this .................... day of ................... Notary Public, . ................................................... County ..~......~..~..~...~......~.....~...~.~......'~. ............................. (Sig na~/qE applicant)