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Home My WebLink About10560-z FORM NO. 2 TOWN OF SOUTH OLD 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? 10560 Z Date ...&($f<:.(4C7.... C?.,.. ..'. 19.ro.. Permission is hereby granted to: .....$I5ZtftT....4...56l.(;Cd ' ....:r.:.sl.CS':i":...IZ&../,I.\./..tiEI:V) :,. " ....:iQQNO'k.Q -;:,..6..1...:':-(...... . , , I to ..c.9.~~.7a(./.a::.....'O.t...lZ....F.:.ku.(.t,.7...../)(A.H::/ILtf..,:l',....,F.~~"...".,.. , ............r:.-;r.6:1.6.te:.f.E'-......<r.....:57.E.I..,t,.,..XJ.... Hl5i:.c../........ ..,..,............... .. ............, at premises located at ...~7..":I..~.~,C.fi 7....~-:T...ii5.t'9.(;?........,..,.................,.. .. ...,..",...............,.,....,....,................................... . . ". ............~7...f.:iA4LGI!,)I-..M..y!.... ;;:we.,R.zy(J~..E:S:7Ar,z;5.......2!. ;$7.4 .:i...............l.9...Z:!!./..9.............. ,..,...... ,. pursuant to application dated ....I::7::.;;:?...../I.... ,... ........ ......,.." 19?O, and approved by the Building Inspector. Fee $.Io.3.E.. < '-I k..............m ' \ r, J~ /i )"Xil I ;f r j, .I '1 t};(~.~ .. / .1;/ / uildmg Inspector '4_X \ \ . . z>/ \fV. ,.n \\l.,\)o\ . y ) () p ti \~) u ,) "" , I ,.J _~_ ~.> > , FORM NO.1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 Examined.4;;. :>. . , . . . ., 19 fP TEL.: 765-1802 Application No. /O.s-< Q....... Approved .cX.! ("5,...... " 19~PennitNo. ./O~:<Ot Disapproved a/c , , . :-: . ~.-:. . . . . . , .. . .,...".,..,.., 1J . zJ.. ...............j'd ... _!tt:? . ~~~ .. '.... ... ..., .........., /' (Buildin nspector) . APPLICATION FOR BUILDING PERMIT ~ Date .~... /( ...., I${). 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 Pennit to the applicant. Such pennit 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 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, building code, housing c~lations, and to admit authorized inspectors on premises and in buildings for nec~s.s~Wf:. -t4.. . . . . . . . . . . . . . . , . . . . . . . . . r. (Signature of apPlica~POration) 6'4'- 5'5~. .~... ...............~.... (Mailing address of applicant) 1117 I State whether applicant is owner, lessee, a~~~/ne:al contractor, electrician, plumber or builder. ...............,.......~...~..~..........,......... Name of owner of premises . ,...'.....,..",...,..".............................,..,............... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authonzed officer. ..................... . .................... . (Name and title of corporate officer) Builder's License No. ............,............ Plumber's License No. . ,7'a. k .~ I( " (- Electrician's License No. ...................,. . Other Trade's License No. " ..............,.. . I. "'''noo orlond" whioh "roG will '1r'. ............................... ,. . . . . . .. . .. . . . . . . H~~~~;::~;"'"'' .',.,...,., . 'Str~~~T.. '~'I'(;I~""""'"'' County Tax Map No. I 000 Section ,. .0).;{(. . . . . . . " Block '., O.r. , . . . . . , . . .. Lot... 0/.7. , . . . . . . . SUbdiViSiO~~~. .4t~......... Filed Map No. ..? 7c? P...... Lot. /1?......... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction. a. Existing use and occupancy, . . . . . . : . . . . . . . . .. . .~ . . . . . . , . . . . . . . . . . . . . . . . . b. Int~nded use and occupancy .~. ........................... .?:fl.:..................... , . i , ""-~~ "j dt , "'" /' 3. Nature of work (check which applicable): New Building. . . . . . . . . . Addition. . . . . . . . .. Alteration .......... Repair .............. Rem'oval . . . . . . . . . . . . .. Demolition .............. Other Work. . . . . . . . . . . . . . . ~, #; "2 'i17 _ (Descriptian) 4. Estimated Cost. . ..~. ~'!' .~:. .. . . .... . . . . .. . .. ... .. . . . Fee. . 7Q~-:... . .. .. . .. . .. . .. . . .. .. " . .. , (to be paid on filing this application) 5. o '~ [f dwelling, number of dwelling units. . . . . . . . . . . . . .. Number af dwelling units on each floor. . . . . . . . . . . . . . . . [f gar~ge, nlimber of cars ....:.... .~. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. [f business, commercial or mixed occupancy, specify nature and extent of each type of use . . . . . . . . . . . . . . . . . . . . . 7. Dimensions of existing structurrs, if any: Front. . . . . . . . . . . . . . . Rear .............. Depth............... Height ............... Nurpber of Stories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dimensions of same structure with alterations or additions: Front ................. Rear . . . . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . . . . . :. . . Height . . . . . . . . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . . . . . 8. Dimensions of entire new construetion: Front. . . . . . . . . . . . . .. Rear . . . . . . . . . . . . . . . Depth ............... Height ............... Nurp ber of Stories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. Size of lot: Front .. . . . . . . . . :. . . . . . . . . . .. Rear...................... Depth ...................... 10. Date of Purchase .......... i. . . . . . . . . . . . . . . . . . . Name of Former Owner ............................. II. Zone or use district in which p~emises are situated. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. Does proposed construction vi~late any zoning law, ordinance or regulation: ..~......................... 13. Will lot be regraded ~~. . . . Will e~ess ~removed fr~e~ Yes No 14. Name of Own:r of pr ises.. " . . ... . . . . . . . Address J1!f:... .~.. ane No. .. . . . . . . . . . . . . . Name of ArchItect ..... .. i:I': ............... Address . . . . . . . . . . . . . . . . . . . Phone No7(".r.-. .S: r-.$. 5. . Name,of Contractor. . . . . . . . '. . . . . . . . . . . . . . . . . . Address. . . . . . . . . . . . . . . . . . . Phone No. .. . . . . . . . . . . . . . , PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or propased, and, indicate all set-back dimensians from property lines. Give street and block: number ar deseriptian according to deed, and shaw street names and indicate whether interior or corner lot. : - 5EE~ n,o,uS <If- S""'U/C.L/L?j' W~ '" rJi.P , . ' , , \' oS~ . . .a.. . . :. . . . . . . .. being duly sworn, deposes and says that he is the applicant (Name of individual sig>>ing contract) above named. 'h ~ He IS t e . . . . . . . . . . ',' . . . . . . . . . . " . . . . , . .'. . . . . . . . . . . . . . . . . .. . . . . . . . . . . . ',' . . . . . . . . . (Contractor, agent, corporate offieer, 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~ained in this application are true to the,best of his knowledge and belief; and that the work will be performe~ in the manner ~et.farth in the application filed there'l'(ith. Sworn to before me thIS \, \ ' ......... ././..~.... .dayof... .~, 198'0 NotaIY Public, ......~., ounty' ~" I, , , I . '~lIZ ETH ANN NEVILl! .., .......................... (Sig~~t~;e'~i~~~lid;;t)' ~OTA~Y P BlIC. State of New York No, ,52.8125850, Suffolk co'1h Te(~ Expires March 30. 19. ,