The URL can be used to link to this page

Home My WebLink About9153-z FOI~M 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? 9153 Z Permission is hereby granted to: .................... ~.e..~.~o..z.~ ......................................... at premises located at .~.../..~.....~..e...~....~.~..o....]~......A...~.? .............................................................................. C~teho~e !~ ,~.~ · pursuant to application dated ......................... .~..~.~.....~..? ............... , 19..?~.., and approved by the Building Inspector. Fee $ ........................ Building InspectorI BOARD OF FIRE UNDERWRITERS BuREAu OF, EL~ECTRIcITY ~ ,~ '~'~ ' ' ~ ' · ,~;i . ~7i IN STREET. NEW YORK, NEWYORK,10038 ~ ~: '.;::~ w~w::W~d~i~wson. 06q0 ~New~ Suffo~ Ave., Cutchogue, L.I.. ~ '~ '-.~ " ~ ~ '~ ' ~ 2nd F~ .... ' ........... Section Block TOWN OF $OUTHOLD ~:~,,~ .~-.~~ ~-~ ~ // .UILDING DEPARTMENT ~~*'~*~d,O., ~/ TOWN OmC ~UTHOLD N.Y. ~/~///- ~/~ ~'~ ~ Disopproved o/c.. ......................................................... ~. ........ o~}~..}~ ~ ~ ................................................................... ....... / x ..................... ~.....~ ....... / ............. t ......... 7~ /~r~ ~'~ ) * (guildin~c~r) / [~ ~'V / o. ~his ~pplicotion must be completdy filled in by typowriter o~ in ink ~nd submittod in triplicate to th* 8uildino Inspector, with 3 ~ot~ o{ plans, ~ccumt~ plot plan to ~olo. Foe occordino to schedule. b. ~lot plon showin~ location of lot ond o{ buildings on premises, relationship to adjoinin~ premises or public streots o~ ore,s, ond ~ivino ~ detoilod description o{ [oyout o{proporty must be drown on the die,rom which is po~ o{ this opplic~tion. c. Tho work coverod by this opplicotion may not bo commencod bofore issuonce of Buildin~ Pormit. d. Upon ~pprovol o{ this opplic~tion, tho Buildlno Inspector will issue ~ Buildlno Pormit to tho opplicant. Such permit sh~ll be kept on the premises ~voiloblo {or inspection throughout the work. e, Mo buildino sh~ll be occupied or usod in whole or in p~r~ for on~ purpose wholever until ~ Cortificoto o{ Occupancy sh~ll have been omnted by the Buildin~ Inspector. AP~UCATIO~ IS H[R[BY ~AD[ to the ~uildino Deportment {or the issuance of o Buildino Permit pursuont to the Buildin~ Zono Ordinonce of tho Town of Southold, Suffolk County, ~ew York, ~nd othor opplicoble kows, Ordinances or Renu ot OhS, for the construction of buildings, odditions or olterotions, or {or removol or d~molition, ~s herein described.~ The opplicont ~mes to complg with oll opplic~ble Iows, ordinonces, bui dlno c~o, hous~n~ code, ond ro~ulotions, ond to odmit authorized inspectors on premises ~nd in, buildings {or n~ess~ inspections. .................... 3 (Si~notum o~ opplicont, or homo, i{ ~ corporotion) ~ State whether applicant is owner, lessee,,flg~nt, architect, engineer, general contractor, electrician, plumber or builder. ........................ ............................................................................................ 'N'~'r~ of owner of premises ~,,~/~ ..~.../~..~..~.-. ~-.~""~-..~... If opp~t is a corporate, signotu~ of duly authorized officer. ...... ~ (Name and title of corporo~ officer) Builder's License No .......... .~....~ ............................... Plumber's License No -~,'.X/./,d .................... Electr,c'an's License No.~4'.~..~..~. ................................ Other Trode's License No ............................................... , .~/<~"~' 5 ~] , ,,',~ - 1. Location of land on which propo,,~d work~l be,clue. Map, No.: ..~.~.~¢~ .~.~...~.)Lot N~, ....~....:; ........... Street and Number .... ~.~..~.',~. · · .~:~,~/. · '~.. ~.'.~ .~' · · ~' · · '~'~' · ................................. '~'~' Xt'~' ~u'~ j i ~.~ ........ 2.State existing use and occupancy of premises ar~J~%nded use and occupancy of proposed construction: a. Exisiting use and occupancy .............//,~.,/,,~,~..~.~.,~.~..~....~... ......................... :~ ........................................ b. Intended use and occupancy .................... ..//..~....~._..~........./'.~.,,,~..~.',~...~.~i~..~.... ........................ 3. Nature of work (check which applicable): New Building'. .......... Addition .................. Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work ................................................ . (Description) 4. Estimated Cost ................... ,¢.~ ................................... .~.,,.:~.. .................................................................................. (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. If business, commercial or mixed occupancy, specify nature and extent of each type of use ~..~.....~... .......... 7. Dimensions of existing structures, if any: Front .....~.(2...~....~.. ......... Rear ................................ Depth .................... Height ........................ Number of Stories .................................................. ~. ........................................................... Dimensions of same structure with alterations or additions: Front ...... ~....~... .......... Rear ............................ Depth ................................ Height ............................ ~-,-',,,~Num~/~r of Stories ................... ,v ........... 8. Dirnensioas of entire new construction: Front ....... ~...,,,~....~. ................. Rear ...... ~'~.~,....~. ......... Depth .~...~... ............ Height ...... .,'~...?~.. ...... Number of Stories ............~ ........................................................................................ /. .......... 9. Size of [at: Front ................./..~:...O.. ........................ Rear ........... ./../.~.. .................... Depth,~..~..~..~..'~..? 10. Date of Purchase ..................../...~....,?....~.. .................... Name of~ __ ,.~.~.---.-..............,.,.,...................,.Form~_O~er ~..~...~..., ,'~ 11. Zone or use district in which premises are situated ................ ...,,~..~...~.~...~..Q~,:..~..~Z~r.--v'./.'.'"'",'""'"".'"'"'"'"'"'"" 14. Name of Owner of premises .~...~...~.~.~...~~.r2~d res~....~ ...~t. ,~.*.... Phone No.~.~.~.....'~....~.. Name of Architect ........................ ; ......... ; ........................... Address ................................ Phon* No ....................... Name of Contracto~.~..K'..-~.'~...~.,,~.~.~...~ Add~~.....~, ..~."... Phone Nc~..~...-'.~..~...~...~ PLOT DIAGRAM Locate clearly and distinctly ail buildings, whether existing or proposed, and indicate all set-back dimensions frorn 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 NEV~.¥¢J~. ~ ¢ ~ COUNTY OF ..?..~.~5.?.:~,.~, ............. ¢¢'¢ ............................................. ~.~...~.~.~ ....................... being duly sworn, deposes ~nd s~ys that he is the ~pplicenl (Neme of individuql signing contr~cf) ~bow~ n~med. He is the ............................................. g~.~ ............................................................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work a~ake and file this application; that all statements contained in this application are true to the best of his kn~edge a~d belief; and tk'~Jr~oSw ~}~r~i~Zrf°rmed' in the manner set fodh in the appllcation,~ filed therewith,x , day of ~eh , 19 ?~ "~2 . ,/. 31mt ............ ::::::::::::::::::::::::::::::::::::::: ....... ............................. ~ ELIZABETH ANN NEVILL~/ NOTARY PUGLIC, State of New No 52.8]25850, Suffolk.~nty Te~m Exp~r~s M~rch OWNIJR: TITU~ SC:ALE: .... , . FOR APPROVAL OF CONS'I~PI'I<~N ONI~Y' ' ' ' SUFF, CO. HEALTH DIPT, APPROVAL I H. S. HO.?' $0"~1~I C UTC~O~ ~ O' DENgg WiLL ~F~M ~ THE