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Home My WebLink About8533-z FORM NO. iS 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 ^UTHORIZED) N? 8533 Z Permission is hereby granted to: .CC,/..~...~o.~m...~ee.'~ t,~.....'~,.we..~hee~ ~ ............ ...1.~.O~.....;:~c~t;e,,uk..~;~,,~k,~ ....... ~a~.t,.~g ..... ~o .~.~.%~....z).o..W.....o.~.e.....C~.~L.~..~:;.:~.~;;.~ ..................................................................................... Lot t~ l:inor ~ub ~ 9.~ ~Ca~ola-Laurie Pro at premises located at ..................................... ~. ............................................................... D.t.). ............. ............................... D~f...g~.~b~ ~d .. ~ ~.ae.t ......... Or. ie~ .............................................................. pursuant to application dated .............................. ~'~.~1.....1 ....... , 19...~.~, and approved by the Building Inspector. Fee ~.'.'7. · :.)..~.~. ............. ~uildlng insp~tor t TOWN OF SOUTHQLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. Examined Approved .................. !.I ....... ..~.....~......, 19..?...~. Permit No..~..~..D.~......~..:~.~. ..... Disapproved a/c ............................................. L/ (l~ilding Inspector) / / APPLICATION FOR BUILDING PERMIT Application No....w.....-:'....~.;..~.. .......... INSTRUCTIONS a. This application must be completely filled in by typewriter off in ink and submitted in triplicate to the Building Inspector, with 3 set~ 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. 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. ~ '~_~.~,, ' (~igna~ ~plicant, or name, if a corporation' /~--g~ ~ ~ (Address of app)icant) S~t~ a~t is owner~ lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. OwneP Nome of owner of premises ....~R.g..b..e..t7..~....C..a..~..~..L.a..~....L'.a...q~.j..e.~...P.~.9.p..~.~.~j.~.~ ................................................................... If applicant is a corporate, signature of duly authorized officer. ............................................................... P.l?.~ ~.~ .............. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No. C ~Y~'~' Electrician's License No ....... ,,~,~,~;,.C'.,,~,,~,,~.,,~ ....... Other Trade's License No ...............................................7~/f~. y // ~ 1. Location of land on which proposed work will be done. Map No.: .~_~~.... Lot No ...... 4- ................. Street and Number ...~.....O..:.~?......g.~.~.....O...~..c..h...a.~..d.....S.~l?.~.f~.t; ........... ~ ................ .O.~.J,en.t, ................... 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 ................................................................................................................................ 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work (Description) 4. Estimated Cost ....... .~.,~.~[,,..~...0..0..~..~..~.. ............................ Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ....... ~n~ ............. Number of dwelling units on each floor ............................ If garage, number of cars ........O.t~. ............................................................................................................................ 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 ................................ B. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ..................................................................................................................... 9. Size of lot: Front .....~,~..,.~..8.....1{..0...~.......~...~..~.....~..~.~ ......... Rear ......~..0..0 .............................. Depth ..,4.~.0.. ....................... 10. Date of Purchase ......... I.~.~..'.~ ...................................... Name of Former Owner ........................................................ 1 1. Zone or use district in which premises ore situated ............ .l?...e..~...i...d~....n..~...l..a...I. .............................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: .... .N~. ............................................... 13. Will lot be regraded ..I~.~.~ .................... Will excess fill be removed from premises: ( ) Yes ( X} No 14. Name of Owner of premises ...~llta.~..j.~...l~.~p~l~.ll;.J.~a ....... Address ....~lll~;.J~ ............. Phone No.~..~.Jl.~.,~,~..4.... Name of Architect .............................................................. Address ................................ Phone No .......~ ............... Name of Contractor ..F..I~..~III.I~..J~I~.I~ .................................. Address ..~..~.~.~10.[.~. .......... Phone No.~..(3.~,'..~.4~..0. .... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate oil set-back dimenfions 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 NEWnYO~,x~~ · ~ ¢ c COUNTY_OF .~/~,...~...,~..-T~...~.....~~) (lXlbme 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 pedormed the sa~d work and to ~k~ and file this application; that ali statements contained in this application are true to the best of I~is knowledge and belief; and that the work will be performed in the manner set fo~h in the application filed therewith. Sworn to be~re me this ~ ...... :~.~.... da~.~.~.C..~. .................... , 19~.~.. r~ ~ ~ ~ Nota~ Public~..~~ ......... ~~.....,~ .~.~..~. ~.,~. ~ ........ /~~/~~~~ ' /' {Signature o~ app,icant) / SUFFOLK COUNTY DEPARTMENT OF HEALTH SERV~CE~ .. ' l~OR APPROVAL OF CONSTRUCTION ONLY APPROVED Q ' rEST 0.0 NOTE: · -' MONUMENt W4TEN SERVICE- PRIVATE WELLS NEA~£Sr w4rER M41N = $ I~IKEE + \ OOPIE~ OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYOR'S iNKED SEAL OR EMBOSSED SEAL SHALL NOT BE CONSIDERED REVISIONS YOUNG & YOU~ ,,oo osT.*.DE. ALDEN W. YOUNG UNG AT ORIENT *UA~A~*~. to: " TOWN OF SOUTHOLD SUFFOLK CO., N.Y. a~~ ~, SCALE: z J DATE: N APPROVED AS NOilE,I~ NOTIFY BUILDING [~EPARTMENT A J ......... -7 L.J l /?L/" ~ ,t