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Home My WebLink About10556-z FORM NO. 2 TOWN OF SOUTHOLD 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 AUTI10RIZED) ~. rj N~ 10556 Z Date ..;),4/1.;.(,;/11.<<.1.....2../.......... , 19ff.'.Q Permission IS hereby granted to: ~ ...............(1Y:f.~[L.:....GiIt..(4.f.:t;{&.. ,..... -- ..........././.(.I.....//4/./.0...:5j:;.. .(1;(:t;.Z.i.Vf91C// - Iv 1-1 ..4. /c..... .jd/.J./2tu..I..t..UCf:.,. .l.i.Q, ~.c:~~~ e. ::r:. b / <::;7 ad. CC - ~ - ~ Q1. to ~~. ..CJ../~7&::."<-:<'.. ......... ..::.-0......,_.. ..,0 ...' .t..c......f::/,;,I.I..<.C.;;.....o.&..-t:.1?5/.ii. ! ......~r-7......I..I.I..I.(;.....".,....,...,..."...........,.,..::....................~.............................,..,... ., at premises located at ...............(.lj5,.......f:/d/../u.../(Q.&I2/.....,t.I.2SZ..!:I,<;!f;:().4j,/v 7" -.Ie (0 -, -, ~ ......,.....................:;::X........../....I.."..... ..... ..,.... . ..,.. ..................................................,......,.......,.... " ,.................................................................. ................ ......................................................... ................ pursuant to application dated ......:;;;/.....;.t..t.!J~~....2.(.,......, 19.fa, ond approved by the Bulldmg Inspector. Fee $../s.~...... , ;; j ~,. ,>1, !i, " . fORM NO.1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765.1802 --- Application No./C?;'?$( .-c!-:'. . . . ExaminedJ4f/ ,Z.'l, . ,.,19 H? Approved 0?~J. .?-, 9. . . .. , 19 (Q Pennit No. /0 ;(::[( Disapproved a/c ..,,:, , . . . , . . . . . , . , . . . , , , . . . . . . . . . .. .... ,- , . (Building Inspector) APPLICATION FOR BUILDING PERMIT .--- Date cU1J.. .0.7. .. .. ., 19@ 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 Penn it. d. Upon approval of this application, the Building Inspector will issue a Building Pennit to the applicant. Such pennit shall be kept on the premises available for mspection throughout the work. e. No building shall be occupied or used m whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Buildmg Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Pennit 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, buildi g code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary in tions. .... ....................,. .,. Signa}, of a PliC~ name, if a corporation) ....IN ..~~r)/. ... ~ ~t:.......,..... (Mailing addre s of appli ant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......... .,. ............................................................................,.... Name of owner of premises .., .I:~.<??? 8/ vi:.' , . . ~~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (as on the tax roll or latest deed) If applicant is a corporation, sIgnature of duly authorized offIcer. ..... ......................................... (Name and title of corporate officer) B'ld ' L' N 3.~-F ill er S lcense Q...,'...;-; . . . . . .......... . Plumber's License No. ..,....., ............. . Electncian's License No. ., , . . . . . . . . . . . . . . . . . . Other Trade's License No. . .................. . I. Location of land on which proposed work will be done. .....,....................,...................... ./977.6.. ....<;/$ ..,'.. ,.. .~/i;,. /d:~P .'..........,.. .~R,/~&df?j.iI.f;. House Number Street Hamlet County Tax Map No. 1000 Section .,. (j};.r. . , , , , . . . .. Block ... 9 ~. . . . . . . . . .. Lot.. G/.I:. . . . . . . . . . . SubdivIsion ... ,....... 0'................ . . , . . , Filed Map No. . . . . . .. . .. . .. . Lot. . . . . .. ' .. . , .. . (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: , , (?t';V= k!,Utt.' ~ -//...<..c . a. EXIstmg use and occupancy . . .. " ....r.: ... "2' .. 't::.. /....2............... '::": . . . . . . . . . b. Intended use and occupancy . .5.4./.i3. . . y. ~~.t;, . d.4. .I;'o:":~~/' 01.<1.'1:, . ~. . . . . . . . i j " L ,,;t " 3. Nature of work (check which applicable): New Building. . . . . . . . . . Addition. . . . . . . . .. Alterati,QJl............. Repair .............. Removal . . . . . . . . . . . . " Demolition .............. Other Work. /;7!;:R.<:;S. . . . , $.::k-~ g:J:?:' --tS ~, (Descriptian) 4. Estimated Cost. . . . . . . . . . . . 'i' . . . . . . . . . . . . . . . . . . . . . . . . Fee. . '~. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (to be paid on filing this application) 5. If dwelling, number of dwelling units. . . . . . . . . . . . . .. Number of dwelling units on each floor. . . . . . . . . . . . . . . . I If garage, number of cars .....'................................................................... , 6. If business, commercial or mixed oceupancy, specify nature and extent of each type of use ...................:. 7. Dimensions of existing structure's, if any: Front. . . . . . . . . . . . . . . Rear .............. Depth. . . . . . . . . . . . . . . Height, ....... . . . . . . . . NUmber of Stories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dimensions of same structure with alterations or additions: Front ................. Rear . . . . . . . . . . . . . . . . . . Depth '. . . . . . . . . . . . . . . . . . . .1. . Height. . . . . . . . . . . . . . . . . . . . . . Number of Stories. . . . . . . . . . . . . . . . . . . . . . 8. Dimensions of entire new constr)lCtion: Front. . . . . . . . . . . . . .. Rear . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . Height ............... Nuniber of Stories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. Size of lot: Front. . . . . . . . . . .,. . . . . . . . . .. Rear...................... Depth ...................... 10. Date of Purchase ...........j.................. Name of Former Owner ............................. II. Zone or use district in which prdmises are situated. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot, be regraded ...... .t.:/:.: . . ...:);:1':. .., .. . . Will exc~lkr,~oved ~m premises: Yes No 14. Name of Owner of premises~4\./.~: .Qj>~~. . Address . ~~tr!~ . . Phone No. .. . . . . . . . . . . . . . Name 0f Architect. . .. . . . .. .,.. . . .. . . . .. . .. . .. Address.. .. . ... ... . .. .. . . . Phone No. . . .. ... .. . .. .. . Name of Contractor. . . . . . . . .'. . . . . . . . . . . . . . . . . Address. . . . . . . . . . . . . . . . . . . Phone No. .. . . . . . . . . . . . . . PLOT DIAGRAM Locate clearly and distinctly alII buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and bloek flUmber or description aceording to deed, and show street names and indicate whether interior or corner lot. ' f../ " ' t I /1 ~O ~. Ir :JfocV()~ r::?t.JC'C 'f .,. j ~ I ,LItO/I...) f?OAJO ' STATE OF NEW YORK, SS COUNTY OF. .<Y.t.I.F.F.'P.1:-.1< .. " . . . . .S-a mu. f?t,.. . . .€}.I;-./.c, K ~(Ur.!. . . . . . . . . . . . . . .. being duly sworn, deposes and says that he is the applicant (Name of individual signjng contract) above named. , He is the.. . . .. . .. . . .. . . .. . .. . .'... . .. . .. ... .. .. ... . . .. . .. . . . ..... . .. . .. .. . ... . . . . . .. .. . . . . ... .. . .. , I (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duty authorized to perform or have performed the said work and to make and file this application; that aU statements cant1/ined in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this : c2Q </-1'-' ! f1~ YO' . '1: 'j,~ '!f;~:;;l:J~Of!" ~m. . ''0 :q" . . ..,19.. . ""~:'P p! P ~ C~ty f# ~M~w~~~ I - NotARY PYGlIC, SI,I. of New Ydrk . . . . .. .~. . . . . . . . . . . . . . . . . . . . . . . . . . . . . No 52.4524771 I (Signature of applicant) Quallfwd 111 Suffolk County ! CommissIOn 6xplres March gQ; 1fI~ ,