The URL can be used to link to this page

Home My WebLink About10642-z FORM NO. 2 TOWN OF SOUTH OLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE pREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N\' 10642 Z APe 30 80 Date ................. .............. ......................, 19........ Permissi~n is hereby granted to: . / r ......~I.4..q.:.'.\......[Cfq:~,'0.. ,.., ...." , , p(1. i3~ 1,;):;- .......... ~.:........... ...............,......................... .......... .................~:(.!...~C..l:..~~.......!?,/!...........~ '.!.,5 g/ to .....L.:ie c.Y............ G...... .k:.~.:-:.~..... )!.~,~, .of..:(.!..... /:. .'.f. .~'. ..../.!.1.../J!.... .~::.::.. ..;;1."}.(/, +. v ............................................................................. .................................................................................. at premises located at ..............?~..:;?.......,~:.~.'. :t......1.~'::r..................................,........."............... . ..................................................................'..d.(r....\!.i."................................................................,...... ,.ti.(.r.::.'.~;......d.,4.::~!!.T....+X!(!...\)X,p~...,! !.!....,...,.j~.r...!.7.....................,............................. pursuant to application dated .............................?}c.'::.....??I......., 19.~.., and approved by the Building Inspector. 0 5C~ Fee $.../.................... ;J" 7:,' ;;~ jll,t ~ / ~ -?7J ~~ ! (00 - h 7 - ::2 - f.r, . /' 'lY1'f/ /\ .#4 . . ................................................................................ Building Inspector --,I i. " ~ &J\~ FORM NO.1 TOWN OF SOUTHOlD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 '1/ TEL.: 765-1802 Application No. . !. c? ~. Y::?-:-' . . . . . ;5'76 ,f-{) Examined. , . . . . . , . . 7' . " 19. . . Approved. .. . . . , .. ~. , . , .,19.. . Permit No./.D..6'y' ~.2--.. Disapproved a/c. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..,.....................".......,..,~....'&/~- ........ .~<(~ .:;x,.. .ft....... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date. 7j.;2. .f. . . . . . ., 19YP 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 appli- cation. c. The work covered by this application may not be commenced before issuance of Building Pennit. 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 Ordmance 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 necessar: inspections: .' .. . /.. . ? . . Jt~.;. ?v.'~~ ~{!q~., P:::J:; . . . '-fO 13:11' I d-- S' (Signature of applicant, or name, if a corpora i n) JJ.j jt~.,d!t;(~~~. //f.'-{Y (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..........O~~....,....,.......,....,....,........,...............".............,... Name of owner of premises .'W~. A ''!a~~ ~ i~t~~t' d~~ci)' . . . . . . . . . . , . . . . . . . . , . . . . If applicant is a corporation, signature of duly authonzed officer. .... ,..,... ,............... ,.................. (Name and title of corporate officer) Builder's License No. .('J~~~.,..... Plumber's License No. ."...,......,........,. Electncian's License No, ... ........ . . . . . , . . . Other Trade's License No. .........,........... 1. Location of land O~Which proPos:d w~rk will be done. .......................,.......,..,.,............ 3./..5.~.. .~, .';(. ~,,/!, ?.(~............... ~~."..,...,..,.......... House Number Street Hamlet County Tax Map No, I 000 sect]: 1'" c:. . t. . . . . . , .. Block . . . . ~. . . . ; . . . .. Lot.....~ ff. . . . . . . ) I SUbdivisionJ.fUJ.~~. . ,A~......,... Filed Map No.j /.7......,... Lot .17......... (Name) 2. State existing use and occupancy of premises and iljtended use and occupancy of proposed construction: a. Existing use and occupancy ,.C~f,,,,,..;:j ~ .12..uk-e.J!f:.-;..-::r. . . . . . . . . . . . , . . . . . . . . . . b. Intended use and occupancy . .v" C;:"hrJ.-.-f... .. ...... .. ~'~. O. . . . . . . . . . . . . . . . . . . . . . . , Ii . , 1 .r. <- $: ~. ' ~I 3. Nature of work (check whicb applicable): New Building. . . . . . . . . . Addition. . . . . . . . .. Alteratioj! .......... Repair .............. Remoyal . . . . . . . . . . . . .. Demolition .............. Other Work . I~. . d ! 0 .::t- (Deseription) 4. (3 IS- Estimated Cost. . . . . . . . . . . . . '. . . . . . . . . . . . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (to be paid on filing this applicatian) I 5. If dwelling, number of dwelling units. . . . . . . . . . . . . .. Number of dwelling units on each floor. . . . . . . . . . . . . . . . If garage, number of cars .....:..,;1................................................................... I 6. If business, commercial or mixe<\ occupancy, specif~ n!!ture and extent of each .!>,pe of use . . . . . . . . . ~ . . . . . . . . 7. Dimensions of existing structures, if any: Front.. 5.4 e. . . . Rear . J: 6. .c). . . . . .. Depth../. .9........ Height ............... Numper of Stones. . . . . . .. ............................................... Dimensions of same structure wi~h alterations or additions: Front ................. Rear . . . . . . . . . . . . . . . . . . Depth. . . . . . . . . . . . . . . . . . . . ,. . Height. . . . . . . . . . . . . . . . . . . . . . Number of Stories. . . . . . . . . . . . . . . . . . . . . . 8. Dimensions of entire new constr~ction: Front. . . . . . . . . . . . . .. Rear . . . . . . . . . . . . . . . Depth ............... Height ............... Number of Stories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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. . . . . . . . . . A-. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. Does proposed construction viol'ate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ........ .:.~~~ Will exce~~oved from premises: Yes No 14. NameofOwnerofpremises'!~....-:.... .. ddresJl...r idi. ..q<'1l:'<-..PhoneN073.V.;-..f-:G:~.+,.. Name of Architect ....... .. ................. ddress................... Phone Na. . . . . . . . . . . . . . . . Name of Contractor . . . . . . . . . . . . . . . . . . . . . . . . . Address .. . . . . . . . . . . . . . . . . . Phone No. ., . . . . . . . . . . . . . PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-baek 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. '><~~ J ~ TMrrr-wd ~ ~ 1 '1' ~ 0 !r1 - , , , , : 50 Sc)UNb AVE STATEOFN~~K 1(: SS COUNTY OF ... .fM,Tp.~ . . i 'E h . . . . . . . . . . . E 11. :e..../ ';t .M . .:. . . ~.. k~ .. being duly sworn, deposes and says th~e is the applicant (Name of indiv dual sigping contraet) above named. .5}Ie is the. . . . . . . . . . . . . . . . . . . . hi . W. N .<::..v-: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , I ; (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 con'tained in this application are true to the best of ~owledge and belief; and that the work will be performed in the manrjer set forth in the application filed therewith. Sworn to before me this . .., .. . ='2,./<$'+. . . . .. . .day ~f.. . . .!4-p. nI. . . ..,198,2) Not"'Po~~. H H~ ,s~/i: Co~(> ~ U ~ I .. ........ . .0. ~.~............ NOTA:;'~~~~~ ~NN NEVI Sig ature of applicant) ~o. 52'8125850~t;~f~fk cow Yor~ IIrm liMp/res ~'r.Ch sa, 1~,9-.