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Home My WebLink About9038-z FORK NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N. Y. .rqm•..: BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AU 44ORIZED) N. 9038 O Z Date .. ... .....��....., 19....7 Permission is hereby granted to: .. ... .. ...'. .. .�.. ........ to .........: ...j. . . .... :...........................fix.rl: trr F7'-C rS/ atpremises located at ....... .............. ..... .. .... .. .. 11dC . ........ •.,� � ....• •. ... .. . ..............:..:... ,� ............................................ pursuant to application dated ......... .�..'....�f.......... ... .. 19.7.2, and approved by the Building Inspector. Fee .IG..`�........... ........ ..... .. . . ../.44.. ... Building inspector t �0A Cep 5 �P i Fo8az NO. Y � TOWN OF SOUTHOLD n BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined . . ........ .�.... ., 19.„1... Application No. ....... . .0 Approved ..... -�.+' r......1�. ....... 19.7.7 Permit No. .. . Q. .Z...... Disapproveda/c ............... ,,. ..,P, ................ ..................................... � 0 .............................. ---,�,... ......... ...... ..... 4:1G:ft - (Building Inspector) APPLICATION FOR BUILDING PERMIT U Date ...........� ............... .. 19..�� .\ INSTRUCTIONS k = 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 adjoining premises or public streets or areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application.I, 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. 6 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'G 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. (Si nature of applicant, or name,.if a corporation) . (Address of applicant) State whether applicant is owner, lessee agent, architect engineer, "'g g , general contractor,,:;electricion, plumber or builder. ...........o 7- ......... ...................................... . .............:........ ........................................... Nameof owner of premises . . . . .. .................................. ................................................. If applicant is a corporate, signature of duly authorized officer. S 14 .................................................................... (Name and title of corporate officer) 6� Builder's License No. .................................................... n i Plumber's License No. ..............................................:. Electrician's License No. ... ... ......................... O V� n �fc'7cJ`r� 1Z Other Trade's License No. :............ . .............................. �I /l� 1. Location of land on which proposed work will be do p No • ,��... .. .: of No.. Street and Number a` r?✓1 r..� . ..... .... .iC,...... ....... . .. ....... ...................... Gnicipality 2. State existing use and occupancy ofpremises and intended use and occupancy of proposed construction: a. Exisiting 'use land occupancy f! ......... .................... ................ ............ b. Intended use and occuponcy��.,��... ....� ........ 3L Nature of work (check which applicable): New 8ui!d\hd. .................. Add or . ' ' Repair ---.--- Den�o|�ion —.. .. Othmr T~ ' rc��- `� ~~ 4. 'Estimated Cost —.--.-- ..... � do be paid on filing this application) � 5. If dwelling, number of dwelling units ............ ----Nun�bar of dwelling units ' each fkoor�'�',-------- � � |f garage, nun�berof cars ---^.-'.--_—'.---'''..°....... ...................................................................................... d. If business, con�n�arcio| or mixed occupancy, specify nature ^ient of/each type of use ------'�=--' ° r ~ «�' ' 7. Dimensions of existing structures, if any: Front ----°`�'��-_- Rear ----------_---. Depth —...'^--- . �� . _Height - Number Stories -.--...-----.--__--_--...-�-.---.~~'----_-__—____. �- ~-.`._._— .. . � Dimensions of same ' structure with alterations or additions: Front .................... ' . - 0mor .................j�......... �� c^�'^ Height ' Nun`ba ' Stur�s ^�^ ' � Oept� -----�--.--- ----------`� ,»/ ' --'--r—'----- �' � . ` ' / O. Dimensions .of entire new construction: Front .---..—....__--.' Rear .............................. Depth -------- ^ u Height ........ Number of Stories ------_—_^----......------------_------_----- Reo Depth 9. Size of lot: Front ------------------- r -----------.--- _ �.�� ................................. 16. Oo+o of Purchase ........................................................Name of Fopmer 0 wnar ........................... .................... x ll. Zone or use district in which premises are situated —_—._—� ---'...v .............................................................. , --~ �l�� -�� l2` law, di regulation: ' ' 2~� 13. bo � � No ' 14. Name of Owner of premise ............ .- Adorass .. Phone No. ' Nome of Architect ...... ...................................................._ Addreos ............................... .Phone hko!`....�..-�,..Y. . � Nome of Contractor ---.--------------.--. Address ................................. Phone No. ....................... PLOT DIAGRAM ' Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set--b-ack.'dimensions from property. lines-. Give street and block number or description according to deed, and' show.,street names and whether interior or corner lot. (Name of individual .signing contract) above named. (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 contained in this application are true to ,the best of his knowledge and belief; and thar the workwill be performed in the manner set forth in the application filed therewith. Sworn to before. me th'is, 4.�................................ (Signature,of applicant) V19 ,j York No. 52-812535r-, County Term Expires r4ardh 30yilp_ ' ` ' FOR~T~ NO, ! TOWN OF $O~TNOI.D BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exomined .... : ............ proved ...... ...... ....... , ,erm,t ...... ~sapproved a/c ......................... ~;.;;. .................. ~.~ ...................................... ' ':?' ..... '~'~uilding Inspe~¥~';i ............................... Application No...~ ......................... APPLICATION FOR BUILDING PERMIT Dat~..~~~' ~ 19.....~...~... INSTRUCTIONS a. This application must be completely filled in by typewriter o~ 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 Iot and of buildings on premises, relationship to adjoining premises or public streets or 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 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 ir~ buildings for necessary inspections. ....... ................. of applicant, or name, if .a corporation) .................. (Address of dpplicant) ~' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~-~ ~-~-~4- -- j ..................... ~....~ ................. , ................................................................... Nome of owner of prem,ses 4.,~¢'..(..,¢.~.~....,,~.'~:~ ~ ~x: ...................... 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 pressed WO_0~rk will be dc(ne//Map N,o-~.~...7~...~dX:-.-.-.-.-.-.-.-.~,,~. Lot No ..... .."~...~. .............. Street and Number ~..~...).....~..~..~.-.~..4/_Z~...~/. ....... ~...~.:..(~.~~~../....~..~,,/.. ....................... ' // 6/~unicipality 2. State existing use and occupancy Of p~.r,e, mises and intended use and occupancy of proposed construction: b. Intended use and Repair .................. RemovaJ/ ................. Demolition ....... x/:'~ ........ Other W,o, r4~..~..~~,~-//"~~ ? '~ ~ ~/0 ~ (De~ni~, 4. Estimated Cos~ .................. ~.~.~ .................. ~ee .g..~/.. ................................................................................. (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 ~rs ............................................................................................................................................ 6. If business, commercial or mixed occupancy, spec ~y nature and extent of each ~pe of use .......................... '~/ ~ /' Depth 7. Dimensions of existing structures, if any: Front ...... ~ ................ Rear .................................................... Height ........................ Number of Stories ........ ~. ................................. ;/~;.~. ................................ ~ ~ ............ .. , ~ Dimensions af sa~ structure with alterations or additions: Front ......... ~.~ .................... Rear ............................ ~ep,h ........ ~.~:--' ............. ~h, ............................ ~mb~, of S,o,~ ....... .~ .................. 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................... 9. Size of ~ot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ....... Name of Foyer Owner ........................................ ................................................ // /_/z/ 1 1. Zone or use district in which premises are situated ................... /....1 ........................................................................... ]2. Does proposed construction violate any zoning law, ordinance ar regulation: .Z'.....~..~....~ ........................... wi,~ ,o~ ~e ,~,,ad~d ...~ ................ W"' ¢~¢.~ ~" b. ,emo,e~~~ ~ 14. Mome or Architect ~~ ............... Addross .,. ~hon~ ~o Mome of Controctor ............................................................ Address ................................ ~hon~ ~o ....................... PkOT DIAGRA~ [.ocoto clearly ~nd distinctly oll buildin0s~ whether existin~ or proposed, ~nd indicate oll set-~ck dimensions {rom property lines. Giro street *nd blode~ 9umber or description occordin~ to deed, and show street n~mes ond indicate ~hether interior or corner lot. ...4'--// Swom~efore me this ........................ day of ..... ..~.?.~.~.~-.?.~..~. ................... , Ic7.~. ..... Notery public, 8u£~o].k County / term Expert, s March 30, )?,~ '" (Signature of applicant) STATE OF NEV~I.~Y~ I ¢ c COUNTY OF~l,iiit~[.~li...]~..~ bmng duly sworn, deposes and soys th~l~ he is th applico (Name of individual signing contract) above named. 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 applicatioo; that all statements contained in this application are true to the best of his knowledge and belief; and tha~ the work will be performed in the manner set forth in the application filed therewith.