HomeMy WebLinkAbout8209-z FOI~ 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? 8209 Z
Permission is hereby granted to:
Zan Zobel
....... ~.1..6..2..~. ....... .s..,o...u~..,~ ~$ ~..A~,e. .......................
~outhold
~o ..~.~.t...z.~...~.e. ~...a..?. ?...e..s...s..°. ~.~.L ..s. ~..°.~.a..~ .e....~ ~ ~.z..d..~ 5~ ...................................................................
................................................................ .$.p.~.t.h...o..z.~ .............................................................................
pursuant to application dated ............................. ~.e.]~..~......~.~. ....... , 1~...~..~., and approved by the
Building Inspector.
Fee $10.00
TEL. ?65-2'660
TOWN OF SOUTHOLD
OFFICE OF BUILDING INSPECTOR
TOWN CLERK'S OFFIC£
$OUTHOLD, N. Y.
December 22~ 197~
Soathold Town Board
16 South Street
Greenport~ N.Y.
Gentlemen;
$10.00 fee
Attached is letter from Zan Zobel requesting ref~ of
as he does not plan to use permit 8209Z - copy attached.
Yours truly
Baildimg Inspector
IrOBM NO. !
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK°S OFFICE
SOUTHOLD, N. Y.
Approved ........................................ , 19..~. Permit No .....................................
Disapproved e/c ............................. ~ · .~-~.'.~ ......
APPLICATION FOR BUILDING PERMIT
Application No...,.,~ ..~..~..~. ...........
INSTRUCTIONS
o. 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 sca e. 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 o detailed description of layout ofproperty must be drown on the diagram which is port 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 o 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 o Certificate of Occupancy
shall hove been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of 'o 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, os herein described.
The applicant agrees to comply with oil applicable lows, ordinances, building code, housing cede, and regulations, and to
admit authorized inspectors on prem ses and in buildings for necessary inspections.
(Signature of applicant, or name, Jfa corporation)
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises ....;,n~?~ ........ .,.;....! .................................................................. : ......................................................
If appticont is a corporate, slgnoture of duly authorized officer.
(Name and title of corporate officer)
Builder's License No ....... :,...z. .......................................
Plumber's License No .................................................
Electrician's License No .............................................
Other Trade's License No ...............................................
Location of land on which proposed work will be done. Mop No:: ............. ?~ ...................... Lot No ........ .~...~. ............
Street and Number - '~ '.; , , .... , .J .... .3. ~. .........................................
Municipality
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Exisiting use and occupancy ' i ' ' ' i~ 7.
3. Nature of work (check which applicable): New Building ..':X~ ........... Addition .................. Alteration ...........
Repair .................. Removal .................. Demolitior. .................... Other Work ................................................
(Description)
4. Estimated Cost ...i ........................................................ Fee ...... .1.. .0. ~.0. ..0. ........................................................................
(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 .............................................................................................................................................
6. tf 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 alteratiohs or additions: Front ....................................Rear ............................
Depth ................................ Height ............................ Number of Stories ................................
8. Dimensions of entire new construction: Front ..... J~ ............................ Rear ...... 8 .................... Depth ..... .1¢ ..............
Height .................... Number of Stories .~le .............................................................................................................
9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................
10. Date of Purchase ........................................................ Name of Former Owner ........................................................
1 1. Zone or use district in which premises are situated ..¢¢.£u~..d..~zg¢¢ ...............................................................................
12. Does proposed construction violate any zoning law, ordinance or regulation: ........ 12.O ...........................................
13. Will lot b~ r:egraded ............................ Will excess fill Be removed from premises: ( ) Yes ( ) No
14. Nome of Owner of premises .~i.....L;~bt,~.'~ ........................... Address .....~.r.~tl.g~'lr~.cl ......... Phone No .......................
Name of Architect .............................................................. Address ................................ Phone No .......................
Name of Contractor ........... zZ',;~,i.¢;'~ ..................................... Address ................................ Phone No .......................
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate oil 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 NEW ,YO,R.K, ~ c c
COUNTY OF ....~]Zb~;.O~iC ........... J"~"~
............... : ........... .~[;.};,~',~...~.",,.(:/.,.'...; ........................................... being duly sworn, deposes and says that he is the applJcanl
(Name of in,dividual signing contract)
above named.
He is~ the ..................................... ~:~.~/.:']:...~.~'...'.;..;.Lz~Z.!: ..........................................................................................................
(Contractor, agent, corporate officer, etc.)
of sold 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
thor the work will be performed in the manner set forth in the application filed therewith.
Sworn to before me this
.................. · ~..~... day of ....................... ~.~."~.~':..'g. ........... , 19..'~,~i'..
Notory Public, . ....................... ,.{l~'~uJ,7~ ........... County
~ (Signoture of opplica ~
nt)
ELIZABETH ANN NEVILLE
NOTARY PUBLIC, S~tate of New Yor~