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Home My WebLink About9220-z FORM NO. S 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° 9220 Z Date ............................fty......$........... Permission is hereby granted to: ............ 111M..111II ,..nl,,......... to .............................................................. ................................................................................................................................................................ atpremises located at 40040'.4".................................................................................................. ..............................................UVA4114............ ................................................................................ ................................................................................................................................................................. pursuant to application dated .....................UP.....:...................., 19..�., and approved by the Building Inspector. Fee $*5*lX........... Building Inspec r FOM NO. Y Xd Iv TOWN OF SOUTHOLDl4 BUILDING DEPARTMENT TOWN CLERK'S OFFICE -��°�7 7 - SOUTHOLD, N. Y. Examined ...............1�..`....�... . ., 19�.�. l ion No. ................................ � 9 _� - l Approved ................................�:..., 19�..... Permit No. ..`.. ��..�...:..: "6/77 ./ �� . � . Disapproved a/c ....::........... . ... ............................. .............................. ...................................................... ............................. ..(Building Inspector). .......................... APPLICATION FOR BUILDING PERMIT n Date ....S/o�................................ ... ` INSTRUCTIONS 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 of property 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. i 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. R 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 necessa insnactions. V ...................................... ....................................................... (Signature of appl nt, or name, if a corporation) a:9 s WA �.iq-k�5- 0 rz- PA-rCr0&VC N . .................. ...... .... .... ..............................7 ......... ..... .... .... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor electrician, plumber or builder. .................................................................................. ................................................................................................................ Name of owner of premises ...,�.�A"qA........S. * 14.12 5 F............................................................................................ If qaant s corporate, signature of duly authorized officer. .... ......... ............ .. .. .. . (Name and ti a of car ate officer) P c Builder's License No. .� C Plumber's License No. ................................................ --- Electrician's License No. ............ ............................... `1_ v OtherTrade's License No. .............................................. 1. Location of land on whi h proposed work will be done. Map No.: ........................................ Lot No. ........................ Street and Number ..�...Q,� ... Q. l s..... ��.,......(..4/+`( ;I JIB ........!q :.................. ... Municipality 2. , State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. . Exisiting.use and occupancy .. ... .. :.L��1`/.Y(.N"L........ ..... b. Intended use and occupancy .......5 !:lr. ......................................................................................................... 1 1% ' � ~� 3. Nature of work (check which applicable): New 8ui|din�................... 'l � ��6itk�n �^--_-. Alteration ............ . Repair ----.-- Removal ------ Demolition--__-- Other Work ------.---------.-' ,- � ' � . ` .w-m-»--~-~,-------- .~ (Description) 4.. Estimated Cost -------�eo ----'_r-----'^---^-^'-~^-----~-'—---'' Ho be poidon filing this application) 5. If dwelling, number of dwelling units ------.--...Number of dwelling units on each floor ............................ Ifgarage, number of cars ........................ ...................................................................................................................... If business commercial or rnhw*d occupancy, specify nature and extent of each type of use .............r_--- 7. Dimensions existing structures, if any: Front ........36�................ Rea r ''YL ...................... Depth ............ Haight ...11.:...... ....... Number of Stories ...... --.-^'---~--'..--..F ' .'----~--^-'^-------- r----- Dimensions same structure with alterations or additions: Front -' ---_-.------- Re -��------. Depth .............. Height ../'#�.....................Number of r~-- '- -- ..................... 8. Dimensions of entire new construction: Front ................................ Rear ............... Depth -------- Haight . Number of Stories --.---.-^-.-----_--_---------------..�.--__,,,,. 9. Size of lot: Front ..... 0M..................-- ....... .......... Rear ........................................... Depth . /5-0-----~6..-.. � -- 10- Ooto of Purchase .............. -.---�---.-----.Nunna of Former Owner --': ........................................... -- 1 l. Zone or use district in which premises are situated -............................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: .....:7:...................... ..................... ~ 13. Will lot be ragroded ---------. Will excess fill ba removed from ( ) Yes K) No � 14. Mon�enf Owner nfpranoisea�T��\'/...�u[��,��---._' ��droso ��` Phmne�� ,.............,....., Nome of Architect . -------------,.. Address . �Phone N�x ...................... /n �� Nonne of Contractor R�Uj!�t�/��-��&6�!�!-----.- Address^�-�. �.��-pbon� �.��..�.. ' . PLOT DIAGRAM . Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions from property lines. Give street and block number or description according to deed, ond .show street nonnos and indicate whether interior orcorner |c*. lorD fit ........6.................6.............................................1)'--4.. ........being duly sworn, deposes and says t hot he is the applicani (Name of individual signing contr cf) above named (Contractor, agent, corporate officer, etc.) - , of said owner or owners, and i' du'|y authorized to perform or have performed the said work and to make and file this application; that all statements contained inJhis application one true to the best of his knowledge and belief; and thar the work will6a performed in the manner set forth in the application filed ther *th. Sworn to *efo�- e this a ' 1 � ___ .. 19 Notary Public, . . County .. .. -_'�4.\.. V-' r . u. ..-.-'..--'.----. (Sgno,vre or o iconr MURIEL BRUSH ~ � NOTARY PUBLIC. State of New York Commission'Expires March 30, � � FOB~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ............... ~....C~...~..., 19...?....7 Approved .................... ~.c ..... ~...., 19.~.~. Permit No .... ..~....~......~....?.....~.. D~sapproved a/c ............................................................................................ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildi~ Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan show~ng location of Iot ond of buddings on premises, relationship to adjoining premises or public streets, areas, and gwing a detailed descrlphon of layout ofproperty must be drawn on the diagram which is part of this applicatiot c. The work covered by this apphcation may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector wdl ~ssue a Building Permit to the applicant. Such perm shall be kept on the premises available for inspection throughout the work. e. No budding shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupanc 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 th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe, The apphcant agrees to comply with all applicable laws, ordinances, building cede, housing code, and regulations, and or ......."i ....... 'g ' Yt~' .......................................................... ppl/i'c6nt, nome, if a corpor~;i~) '" (Address of oppliconf) State whether ~p~hc*nt is owner, lessee, .~ent, ~rchitect, engineer, ~enerol electric~on, plumber or builde Name of owner of premises .... If ~nt,i~'~ co~omte, signature, of dulg out~orized officer. ............... ; i/ii;i ......... Builder's Lic~se No ..................................................... Plumber's bcense No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... Location of land on whk:h~,~oposed~_, -w°rk will be done. M~.p No ...................... : .......... Lot No ....................... Street and Numh~r T"(/'~ Store ex~st~n9 use ~nd occupenc~ of premises end intended use ~nd occupenc~ of proposed construchon: a Exisiting use and occupancy b Intended use and occupancy 3. Nature of work (check which applicable) New Building .......... Addition ..~....... ....... Alteration ................ Repair ................. Removal ................. Demolmor. ................ Other Work ................................................... ~ .~"'000 ~' (Description) 4 Estimated Cost ...'~..~ ................................................... Fee ...ff.. ~ii.' ........................................................................... (to be pa~d on filing th~s application) 5 If dwelling, number of dwelling umts ........................... Number of dwelling units on each floor ......................... If garage, number of cars ..................................................................................................................................... 6 If business, commercial or m~xed occupancy, specify nature and extent of each type of use .......................... 7 Dimens,ons of ex,st,rig structures, if any. Front ...... ............... Rear ...................... Depth .?¢:.....~..' .......... Height .... !.~.' ............. Number of Stones ...... i .................................. :::.~ ............................................ ; ................ D,rnensio? ~:)f same structure with altera/t,ons or add,t,ons. Front .... .~..,~. .......................... Rear ....~..l~ ................ Depth ...... r'~L~'~..t. ................Height .(..~. ................ Number of Stories ..... ./ ........................ 8 D~menstons of entire new construcbon: Front ................. , ................ Rear ............................ Depth ..................... Height .................. h~umb~er of Stories ............................................................................................. ; .................. 9 Size of lot Front .... ..: .......................................... Rear ........................................ Depth ./. .....2 .................... 10. Date of Purchase .................................................... Name of Former Owner ...... .~ ............................................... 11. Zone or use distnct in which premmes are situated ................................................................................................ 12 Does proposed construchon wolote any zoning law, ordinance or regulation' .......- ................................................ 13 Will lot be regraded ........................... Will excess fill be removed from premises: ( ) Yes ~Y~) No 14. Name of Owner of prem,ses .~.~.t-]..~.....~Z. ft~...~.~,l~.. ............. Address .~."{ ~//f1~//~/'(-5 /~ t//~. Phone No. · ........................ Name of Architect ................. J~)6~1~')'/.1 ~11~/("~ ...................... Address ................................ ~7 %~/~h/ Phon~ No ...................... Name of aaress .... ,one PLOT DIAGRAM Locate clearly and dmtmctly all buildings, whether ex=sting or proposed, and red,cate all set-back dimensions fror property hnes Gwe street and block number or descnphon according to deed, and show street names and indicat whether interior or corner lot ETATE OF N COUNTY OF :W YORK, ~ .......................... ~SS ................................................................................. being duly sworn, deposes and says that he ~s the applicor (Name of indiwdual s~gnmg contract) He ~s the ..................................................................................................................................... (Contractor, agent, corporate officer, etc ) of so~d owner or owners, and ~s duly authorized to perform or have performed the said work and to make and fil th~s applicahon; that all statements contained ~n this apphcation are true to the best of h~s knowledge and belief; an tha~ the work wdl be performed in the manner set forth m the application filed therf~jth. Sworn to before me this . / ............. ~.....~ '~ ~-~day ojf ..... i~. ......................... , 19r~ (Signature of al~licant) No B2-4522026 - S,~Wk County ~ornrnilsion Expires M"a~ch 30,