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Home My WebLink About9159-z FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST DE KEPT ON THE PP, EMISE$ UNTIL FULL COMPLETION OF THE WORK AUTHORIZED} N? 9159 Z Permission is hereby gronted to: erect additional frneing as per application April 1 1977 E/S Main Road (~t 2~) at premises located at Mattituek N.~, pursuant to application doted ......................... .~.~.r...~..~.......? ............ , 19.7.?..., and approved by the Building Inspector. Fee $.].~..0..0.. .......... 177 Y FORM NO..1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. N"Rl A ` 7 N! < Examined ��-......./...... ., 19z1.. Application No. . .�............... Approved�......... �.......... f 19. 1... Permit No. .1../.`�l.^7 .......... Disapproved"a/c ... .............. ....................................................................... c ..................................................................................................... �r ............................ .:... .................................... ..... ................... (Building Inspector) APPLICATION FOR BUILDING PERMIT (� Date ......... /.............................. .1 19.?.7.... C C 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. 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. .....:---!'!�: .G.�! ........ ...... ?rtj (Signature of applicant, or name, a corporation). . ............... (Address of applicant) State whether applicant is owne , lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................... .................................................................................................................. r Nameof owner of premises ..... C ..... ......... ... . .................................................................................................... If applicant is a corporate, signature of duly authorized officer. i .... .......... ... ................. ........ (Na me me and title of corporate�f�er) Builders :License No. .............................�..................... 42-2 Plumber's License No. ................................................. r Electrician's License No. ............................................ ;,AN X OtherTrades License No. .............................................. 1. Location of land on whic roposed r i be op No. :............... Lot No. L. Street and Number ..... . . .. ..... . ......'.:.............:.................. . .: : ......... . . 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 ......................i............ .. ........ . - .................................... J � ^ � 3. Nature of work (check whichopp|icob|m): New Building. .. Addition .................. AJterat — ' Reooir ------- Ramovo} `------ Oen�o|ition---.---. Othor�\�ork `--.----.--______.. ,_ (Description) / ~_- �� 4. Estimated Cost --.---��--. ................................... -------.l..�..�.��-~=�� ................................................ (to be paid on filing this application) 5. H dwelling, number of dwelling units ---.------NumberofdwoUing units on each floor ............................ ` � Ifgarage, number -of cars -------------------.---_--_--'--__,--_'----__--_—.--- 6` If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existingstructuros |f any: Front ............................ Rear -------------' Depth ...__---. Height ................ --' Number of Stories ------------�.------.----.--.----------_—_—' Dimensions ofoonne structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ----------Num6er of Stories ................................. 8. Dimensions of entire new construction: Front .................................... Rear ............................. Depth ......................... Height .—.----. �4 of Stories ...................................................................................................................... 9. Size -of lot: Front ........... /»Z?----------... Rear ........... /0-J.—.-----.. Depth -- �^o-v----. l6- Date of Purchase ..........................................................Name of Former Owner ........................................................ 1 — Zone or use district in which premises are situated ---.---------.-------'—.------------.-- l2. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be rognoded --- U excess fill be removed ( > Yes ( } No 14. Name nf Owner ofpremises .. .-----.. Addraso Phone,No. . . Nome of Architect .............'................................................ Address ................................ .Phone No ...................... Nonon of Contractor ---'----------------' Address ................................. Phone No ...................... PLOT DIAGRAM clearlyLocate nctly all buildings, whether existing or proposed, and indicate all set-back dino nsions from property lines. Give street and block number or description according to deed, and show street nonneu and indicate whether interior orcorner lot. y 1-j STATE " ) � ^ ' � � OF — �� .........1�� ' -------.6eing duly sworn, deposes and says that he is the oppUconi (Nome of individual signing contract) above named. Heis the -- ----' ' '' ----''----------'--------'-----------'----- (Controctor, 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 fhor the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ^�4�- .---.� of l9^.�r�.�� . Notary Public nty a L'-'��_----' (Skuro of applicant) ~ -L� JUoITH T. TERRY ' Notary Public, State of New York No, 52-0344903 Duff'o|k noun . . . . Commboion Expires March 30jzy��, ~'02~,~ ~0. 1 TOWN OF SOUTHOLD BUILDING DEFAt~TMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y, £×omined .... ......... ./. ....... , Application No. ~/ ~.i Disapproved (Build~ng inspector) / APPLICATION FOR BUILDING PERMIT Date ......... ..~..~. ............................... , 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 scale. 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 witl 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 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, Suffoik County, New York, and other applicable Lows, Ordinances or Regu arians for the construction of bud ngs, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all appl cable laws, ordinances, building code, hous ng code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. ................... ........ _,(Signature of applicant, or nome, Jif ~/corporationl - ................... (Address of applicant) State whether appl~ant is ownej', lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of prem.ses ....z~-~,~r.~,~.,:~......*~,,~,~.~, .................................................................................................... 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 ............................................... ~ Location of land on whic?/proposed~'~o~k/w~l~ be dgn~./'Map No.: ....... ...: ............. :...~, ........... Lot No .............. Street and Number ..... ~,~....Z..J/.Z..~-.~(.-~'~. .~..~'' ~/~v~¢~"~'?~''['~ ~) ...... ~'~~~' Municipality State existing use and occupancy of premises and in*.ended use and occupancy of proposed construction: o. Exisiting use and occupancy ............. ~,¢,~i~.~,..:......~ ......................... ~-~ .................................................. b. Intended use ond occupancy ........................ ; .................................... '~7' ................................... 3. Nature of work (check which applicable): New Building'. ................. Addition .................. Alteratio Repair .................. Removal .................. Demolition .................... Other Work ................................................ (Description) 4. Estimated Cost ....................... ,,~...~.....~. ......................... Fee ...................... /....~.",....~...~.. ................................................ (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 ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ................... , ................ Rear ............................ Depth ........................ Height .................... Number of Stories ..................................................................................................................... 9. Size of lot: Front ........... ./.~..~). .................................... Rear .......... ./..~..,4) ...................... Depth ...... ~....~....~. .............. 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded ..................... ; ...... Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises~,~...~ .................... Address~,~..~ ...... Phone No.~.~...'";~./~/.~... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ............................................................. Address ................................ Phone No ....................... PLOT DIAGRAM L.ocote clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions frorr~ property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STA-[E OF N~ ~S.S COUNTY ............. '~ '~2~; Z~ ,'J ;: ...... )' ...I/..,.,..~.~..~..../~./.c..,~..(,].(.IK.(~. ........................ being duly sworn, deposes and soys that he is the applicant (Name' of individual signing contract) above named. Fie is the ...... ~,~.~.~. ............................................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hQve 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 tha~ the work will be performed in the manner set forth in the application filed therewith. Sworn to~,efore me this ............................... :¢ ................. : .................................... ~gta~ Public, State of New No. 52-0344963 Suffolk County ~ommissJon Expires ~arch,aO,