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Home My WebLink About10614-z FORM NO. Z 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? 10614 Z Date .................................Ar/\...,..:~.. 18.0.. Permission is hereby granted to: .....fT~.:::{!.~.........yf5.'2.~:,yf...:v....... ".,.,.,., ,. 13<? :!.~.y........J:.::!.:l:..:~.';..........:;:,;,U:~.!.v.:>.. .. I~.' '.1. ..................... ..................... /?t....~ ,'7..0...,'" ,.... to ...../?W.i,.().........h..........Ci~.!.'.K..f.,.... .. .J/. .. ...................... ..,..,...........",.."..........,........... .... .. .. ......................................................... .................................. .................................................................. . (:FA/7/;'Al. AliL: at premises located at .".......,.,.....:..................,....... ,..".. .,...,................................................,.. ....,..,....... ...........,................................. .................,.... ..r.~.e(. ~:5.. :~.. ,..... ...-!:..?. (..:::.'.\:.:!.. .:.........,....... .. ...,.. ,....... ,...................................................................,.... ," .,....,................................................ ......................,. I' . d d 11;1" ':;10 19~;() d pursuant to app .catlon ate .................................,.. ......,............, ........, an approved by the Building Inspector. / jl! 0 Fee $........................ .. ..., ...f/- /' .., Ii'(.( )IV J ~~~ I If "? /I ('0 (,... '1- I? i FH' 8 .....,........ ..........t:.;(1.-I....... I........&A{~.............. Building Inspector , < ._, A ;111. ;, w VII c.:p-r:. r:P^f~6 . S ~ PIt(LKli-l~, ~ ~1I pi. e, ~ \~ Prf<&.Pt w k \t I.( \l t:.. ~ b: w: " , \,) \ ~ , ,8M. " , .4-1l1l=~ if' ~ A Rt> 1> 6L/)f'::,-. '- -....) ~, r, - l1J"'" ... $E11 w /tcL ~ WESt J-f ItR r3>b f( . S Cf3;rGII of w t-lGIlE 'C,' FT. FJ3I'\/c.'d6- 1$ R 13. (Lv6 $ ttS- 1> .6~ F-f. DtJ'fE;J , I ) ~ ~',liiJI 1-. ,.' vl ,~~.~ n:-'1W' .".' . FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ...................~I..~.., 19.~.. Application No ..j/!'~(Y ..,.. Approved ...................?!I/..":......?:., 19...:f.~~!>ermit No. (~.~/.9:f...~ DIsapproved a/c .....................~...................................................... ..,.........................................................................~.....~...............~~..~ -,~/ ......................,....................f::...................::::::......~.~:...,......... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ..................ft.J.f.I.I<.C:tI....,...~...., 19..r 9".., INSTRUCTIONS a. This application must be completely filled in by typewriter or in Ink and submitted In duplicate to the Building Inspector. 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 th,s application may not be commenced before issuance of Building Permit d Upon approval of this application, the Building Inspector wdl issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the progress of the work. e, No building sholl 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, ond other applicable Lows, Ordlnonces 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 ... ....~~,.i~~~~;.~.~6ql;zt~~~.i........ /}~X,...'f~.y,... ,..,E.~€:.~,...*~.?.l1d4..'yV. (Address of applicant) ~'3')O State whether opplicant is owner, lessee. agent, architect, engineer, general contractor, electrician, plumber or builder, .. .... 6.w..d..iP.:A..........,....,..,..,....,.......,...."....,..", .... ...... ......"".. ..,. ..,...... .. ,..'.. . ,..... '....,... '".....,................. Name of owner of premises ........P:4.-.tf.d.,~;:.s..."..,..,..L:.:....,..J)c yt=.N.. . ..,....,.., , ,.. ..... . ..,..,..,............,..., If applicant is a corporate, signature of duly authorized officer, ...... ......................................................................................... (Name and title of corporate officer) 1 Location of land on which proposed work will be done. Map No,' ,....'....,...." ,...... ........ ..... Lot No ..,..'"....,........... Street and Number ..:c..E?JJ..']::1l.4.L.........A.Jl.E-.................E.I.$.tJ:1ff./.J.S.....J.,.sL.4!J.r.,JA..d.Jj. ...., , Municipality 2 State existing use and occupancy of premises and intended use and occupancy of proposed construction a. Existing use and occupancy ........................,.........................,..................................,....,........,.....,........ . b. Intended use and occupancy ............J~,......f:.T.:.........E1?!.{<;:.!..~.(;;.........Ii.~.......P€&..::~~:ic./-f fiI, '-,..,d, ,ii ,1 'PG/'Ic..13- 3, Nature of work (check which applicable): New S",ilsioQ .................. Addition .................. Alteration .....,............ Repair .................. Removal' .................. Demolition.................. Other Work (Describe) ....................................,.., 4. Estimated Cost . ...tf...'3.0.0. I.......... ........ ......... ... ... ..... ..Fee .~..l!;~!?':P... ....... .... .................. ....... ........ .... .... ..........,.... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................Number of dwelling units on each floor ............................ If garag<;, number of cars ....,........................................................................................................................................ 6. If business, commercial or ,mixed occupancy, specify nature and extent of each type of use ............................ 7 Dimensions of existing structljres, if any: Front .......l(p,..~............ Rear .....Lt:...~.................. Depth ...~~..~...... Height .......J~.~........ NumJ:>er of Stories .......1......................................................................................................., Dimensions of same structure with alterations or additions: Front .................................... Rear .........,..........,....... Depth ................................ l;ieight ............................Number of Stories ................................ 8, Dimensions of entire new construction: Front .........3.6....ET.:::...... Rear ......../<3...fT..:... Depth ....~~..eT.:;.., Height .................... Number of Stories ......................................................................,... .....,....,'................,............. 9. Size of lot: Front .......I.~o.L....... Rear .........t1J.O.!................. Depth ..../10./.........,... 10, Date of Purchase ....................................................,...Name of Former Owner ........................................................ 1 L Zon~ or use district in which !premises are situated ..,........<:,.!P..M.M!ii:I2..<;:;..~k."'............C.L...................,........ 12. Doe~ proposed construction violote any zoning law, ordinance or regulation? ........tI.{)..............~........................ 13. Name of Owner of premises f~f.ts..T.....'f4>~.d.Address ..F.~H.f'~.~..N.0>hone No??'!f.7..~~:t.. Name of Architect ......................................................Address ..........................,................. Phone No. .................... Name of Contractor ....................................................Address ..............,..................,.......... Phone No. ..................., PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicote all set-back 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. ~1~TJT$F o~E~~J.......J~ ,..,........;:r.~....~..~....... .~......"..,bejng duly sworn, deposes and says that he IS the applicant (Name of individual signi'i'g appli tion) . above named, He is the ..~....................................................................................................................................... (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 cJpplication; that all statement$ contained in this application are true to the best of his knowledge and belief; and that the work will be performed in tl;1e manner set forth in the application filed therewith. Sworn to before me this : ~ ........2.~..~...ty of .~.:......................... 19..~.~.........::l.~......1>:.......... ...~........, NotOl'Y Public, .....~.~..?Wo.'I!}iI<Y.>..................... County (Signature of applicant) LUCYiJ. AHMJ!N ~otQrv PubJic~ St(1te pf New Yor~ 1'0,2,-0028880 Qualified hl S.dblk Countv9, Tetro exph.~s ..da..:ch 30, 19 t