HomeMy WebLinkAbout9761-z FOI~ NO. 2
TOWN O~ $OUTHOLD
BUILDIN~ DEPA~TM~IqT
TOWH ~LEgg~$ OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
No. 9761 Z
Permission is hereby granted to:
............ ....r~...e.~..e.....s..o.~.~9.~..~....s...o.~.s.....z.q.c..: ........
............ .~.g.....~.~...~.~tL~.~m.~.~... ~ ..~:.. .............
~o .......... .a...a..a....9..n.~.o....~.. ~.~z ~.~ .e....9.~.e....~..am...~: .z.7....~ .e. Lz. ~ .......................................................
at premises located at .............. .~.~..~J,o,,,~r~Ji~..J[~ .......................................................................
.................................................. ~.a.~.9~,....~..~.o..~ .................................................................
..... .~.~.$J,.~g/~..~,~.$.~ ...L.~.I~..]/..S ~...1.q....lg~...~..~...1.1.SP~ ...............................
pursuont to opplicotion doted ......... ~a~ .............. ..~ .................... , 19..7.~, and approved by the
Building Inspector.
Fee $.....JS,.qO. ......
1000-107-09-1~
Building Inspector
FORM ~qO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Examined M.~.y. 31 19...7_8.
Approved ....... ~AY. ....... ~..1. ............. , 19.....~..~ Permit No .......... ~..~.~,1..~ ...............
Disapproved a/c ............. ~~.~.~.~.~:, · ...................................
9761
Application No .................................
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date ....... ~'..,.,5,.Ir., .......................... ,
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 os
areas, and giving a detailed description of layout ofproperty must be drawn 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 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 port 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 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, as herein described.
The applicant agrees to comply with oil applicable laws, ordinances, building code, housing code, and regulations, and to
admit authorized inspectors on premises and in buildings for necessary inspections.
(Signature of applicant, or name, if a corporation)
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
general aon$.r~ctg..~ .
Name of owner of premises M~. & Iv~s. Frank [~ay~or
if applicant is a corporate, signature of duly authorized officer.
(Nome and title of corporate officer)
Builder's License No .....................................................
Plumber's License No .................................................
Electrician's License No .............................................
Other Trade's License No ...............................................
1. Location of land on which proposed work will be done. Map No.: ........................ ; ............... Lot No .........................
Wickham Avenue Mattituck, N.Y.
Street and Number ...................................................................................................................................................
Municipality
2. State existing use and occupancy of premises and intended use and occupancy af proposed construction:
a. Exisiting use and occupancy ...... ~?~'a~?~~?~e:~.~.~ ....................................................
8 aQ~.e
b. Intended use and occupancy ................................................................................................................................
3. Nature of work (check which applicable): New BuUdlng,. ................. Addition ....~ ........... Alteration .............
Repair .................. Remeval .................. Demolition .................... Other Work ...................................................
(Description)
4. Estimated Cost 9~500 . Fee ............ (..i~ .......................................................................
(to be paid on filing this application)
5. If dwelling, number of dwelling units ........ .~.. ................. Numbcr of dwelling units on each floor .......
if garage, number of cars ............................................................................................................................................
6. If business, commercial or mixed occupano/, specify nature and extent of each type of use ...........................
7. Dimensions of existing structures, if any: Front .....~..~. .................... Rear .....~.2. ...................... Depth ...2../4:. ..............
Height 71.2 ~ Number of Stories
Dimensions of same structure with alterations or additions: Front .... ~..2. ........................... Rear ,,4:.2.. ......................
Depth ........... .2.~. ................ Height ............... .2..0...t. ...... Number of Stories ................. .2. .............
8. Dimensions of entire new construction: Front ...... ~.2..t. ....................... Rear ......... ~'.2..~. ............ Depth 24
Height ......... ,2.0...~.... Number of Stories ................... .2. ................................................................................................
9. Size of lot: Front ........................................................ Rear .......................................... 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: ....... .~..o.. ............................................
13. Will lot be regraded . ........................... Will excess fill be removed from premises: ( ) Yes ~ ) No
14. Name of Owner of premises ..~X'.9,.~..~...]~.~.yjD,.o...zt. ..................... Address ~.1;:.1;.:~.t:..1~..9.~.¢. .......... Phone No. ~..8..'..zf..7..7...5....
Name of Architect .............................................................. Address ................................ Phone No .......................
Name of Contractor 13o Horton & Sons Address New Suffolk Phone No. 754-6910 '
PLOT DIAGRAM
Locate dearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from
propcrty lines. Give street and block number or description according to deed, and show street names and indicate
~vhether interior ar corner lot
STA"I'F OF NEW YORK, I S S
COUNTY OF ................................ f"
.... : ................................ ~.e.z'z:.¥...I~,...~4or.ton. ...................... being duly sworn, deposes and says that he is the applicam
(Name,of individual signing contracf)
above named.
I-la is the corporate officer
(Contractor, 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
tha~ the work will be performed in the manner set forth in the application filed therewith.
Sworn to before me this
31st l~a 978
........................ of ............ Z ............................. ,, ........
Notary Pu~...~ ............ ~..f;?~ ......................... Co,nty ...~~..'~.....~..~..~ ..........................
~ ~.~[/~ ,q /--^~ ,_u// //,~ [, \(Signature of applicant)