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Home My WebLink About9478-Z ��v Fo��o. z � TOWN OF SOUTHOLD BUILDING DEPARTMENT � � / TOWN CLERK'S OFFIGE SOUTH'OLD, N�. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON TH.E PREMISES UNTIL FULL CO,MPLETION OF THE WORK AUTHORIZED) i�i� 94'78 Z Date ............................��.�?t...�d..........., 19.7.�.. Permission is hereby granted to: ':!:�.�+.::.:"..:Qut�:�................................................. ....................�.:.:::..::.Y'.,.:..:.�.�.................SQ12;��In�d. ................................................................................ to ..?�Qtr..??z;i,v„<;,�c;,,st;rz:..:.�,??::..:�::��c�1...:it;�:...�c,c,�,�;o,r,v;�....................................................... ................................................................................................................................................................ at premises located at ....Lot�,7,,,,,,,I;;;;;,,,;;r�-i t;c�'�-s ......................................................................................... I.,< �� , ,:��° ��a�.ve ::outhr..lr� ..............................................................:.........:....................................................................................... ...................................•.............................................................................................................................. pursuant to application dated "��.�...��.. , 19..77., and approved by the ' ..............................:.:: ........... . Building Inspector. Fee $�.J.t�'�........... .� E , ._.-.--�-`��_ � � '�:,r n3\ � ��_,'.�'_..-�'. v. ...................................................................... ......... Building Inspector � 1 — �' o�o .� �� i� � �-� . � FOB�I NO. g P , � YOW�1 0F SAIITHOLD �UILDIIVG DEPARTMEtdY TOWId CLERK'S OFFICE . sOUTaOLD, Ne lf. Ex�mined ............��!'/l,l 5��.... ., 19.�� Application No.9�,i`�................ APProved ..................��......3v.... ., 19.�1.... Permit No. ....�7..�c�,.�...... Disapproveda/c ............................................................................................ ' .................................,..�:....................... � ................... ......... .......... - ry ...... ,¢x.�.............. ,,,,,��,....,/ ................................ - ', � � �(Building Inspec r) �►P�LICATION FOR.BUILDIRlG PERM!'�' Date ............(�-�....�.�.v....... ., 1�7..... . � t . , I NSTRUCTIONS a. This opplication 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 fot and of buildings on premises, relationship to adjoining premises or public streets or oreas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of #his application. c. The work covered by this opplication may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspecfior will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throug#�out the work. . e. No building•shall be occupied or used in whole or in part for ony purpose whatever until a Certificate of Occupancy shall have beerr 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, and other applicable Laws, Ordinances or Regulations, for�the construction of buildings, additions or a�terations, 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 necessary inspections. , � � ,...........:..................................................................................... ., (Signature of applicont, or name, if a corporation) .................................................................................................. � (Address of applicant) State whefher ap�licant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. C��'yt�i� ..................................................................................................,................................................................................................. Nameof owner of premises ..!iv..�:�....��..�. .......`��'�..................................................................................................... If Qpplicant is a corporate, signature of duly authorized officer. ........................................................................................ (Name and title of corporate officer) Builder's License No. - ...... .(�vvu�J....'{.�:�... Plumber's License No. ................................................ Electrician's License No. ....��:::................... � Other Trade's License No. .............................................. < 1. Location of land on which proposed ork will be done. Map No.: ....................:�::�..�..��... Lot No. ......��....�........... Streit and Number ..f.��.s....��......!�!J..:.......��.1.�: .:.......... ......... .......... � Municipality 2. State existing use and occupancy of premises and in±ended use and occupancy of proposed construction: a. Exisiting use and occupancy ......1....... ...P...........�. ....... .................................. ............................................... b. Intended use and occupancy � .....�.'.q' ��`J�l.:.......................................................... ............................. . .... . ....... ......... 3. Nature of work (check which applicable): New Building• .:................ Addition .................. Alteration ............,. . . �_. � r • Repair .................. Removal .................. Demolition.................... Other Work ................................................ ... - � �ro (Description) - d � . 4. Estimated Cost .............'�.�..0�......................................Fee .......................................................................................... � (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................Number of dwelling units on each floor ....-,...................... Ifgarage, number of c�rs ............................................................................................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or a��itions: Front .................................... Rear ............................ Depth ................................ Height ............................Number of Stories ................................ 8. Dimensions of entire new construction: Front .................................... Reor ............................ 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 ..................................................................................................... 12 Does proposed construction violate any zoning low, ordinance or regulation: ........................................................ 13. Will lot be regraded� ............................ Will excess fill be removed from premises: ( ) Yes ( ) No 14. �dame of Owner of premises .................................................... Address ................................ Phone�,No. ...................... Nameof Architect .............................................................. Address ................................ Phone� No. ...................... Nniiie of Contractor ..................................... .............:........ Address ................................ Phone No. ...................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whetner existing or proposed, and indicate all set-b�ack dimensions from property lines. Give street and blocic number or description according to deed, and show street names and indicate whether interior or corner loi�. % � - � . ��L� . v�� ., STATE OF NEW YORI<, t S.S COUN i Y OF ................................f ....................... ... ...... ...........................................................being duly sworn, deposes and says that he is tne applicani (Name of individual signing contract') above nomed. Heis the ............................................... ............................. .............................................................................................. (Contracfior, agent, corporate officer, etc.) of soid 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 coni�.ained in this applicotion are true to the best of his knowledge and belief; ond thar the work will be performed in the manner set forth in the application filed therewith. Sworn to bef re me this � � �L � ......�Q..... ... day of .....�...�!...•....................... 19..r.�... /�e! .T¢_. N ota ry P i c .... Cc.�(•`"...._ /� :.... � 1�-'.� :?......... ... ................................ County ............... .................... ................................................ � � (Signature of applicant) ��5��.�L��r;�"' � ARY E DAWSON NOT PUBLIG, State of New York No. 52•4643721, Suffolk Coun �erm Expires March 30, 19� l�t,� ��'� �-�� t� /'�l��x 7 _ �� G�.�� U�� Foaaz xo: r� � � ' . �,�' �,� � ,�. G�� ,�2�� ,� � � �' �� ' TOWW OF�SOUTHOLD �� _ �- — �.� �v V�''`r �UILDIt�IG DEPAR'PAAE�IT� "� � �� Q�, . , � TOV�N CLERK'S OP�ICE Z� v��-�''� " � trn ��' � SOUTHOLD, N. v. � !� �� U. �.� ~ � �� e Examined ......... ..�.�-�'.. ...'......:J.�... ., y9.�� APPlication No. ..�..�.�."......�.........0 APProv�d ............�'..'.�..��.... ., 19.�). Permit No. ../...�..z.�..�:::...��'� — G�-t�tc/%r/'v�,C, �GC � � J , � �/Disapproved a/c .............................................:.............................................. � � ............................................................................. ........... ......... �� N � � ' t7� G � ................................EBuilding�Inspector). ........... ............... W ✓ A�PLICATION FOR �UILDING P�RMIT - � ' Date ..........:��....�.v..... 19�.�..... �`' .., �.c INSTRUCTIONS ` � � - r,, a. This applicotion 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 locatior�of fot and of buildings on premises, relationship to adjoining premises or public streets or ?� oreas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part 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 part for any purpose whatever until a Certificate of Occupancy _ shall have beerr granted by the Building Inspector. � r�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 Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removol or demolition, os herein described. The opplicant agrees to comply with all applicoble laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and irr buildings for necessary inspections. W . � ,...... ................ ..... .......................... ................... .......� (Signature of applicant, or name, if a corporation) C 1 ..................................................................................................� (Address of applicant) State wheYher ap�licant is owner, lessee, agent, architect, engineer, generol contractor, electrician, plumber or builder. �'C�-�`-�`--- . .... .....................................................................`...................., .... ............ , .. ......................................................................... ... Nameof owner of premises ..............`!�l.GL�....��...... .................................................................................... �� . I �'�'' ant is a corporate, signature of duly authorized officer. %: \'(Name and title of corporate�officer)� �� `y ^Builder's Lice�nse No. ...��'�.....�...�'..�C.��`V � ^ Plumber's License No. ................................................ $ Electrician's License No. ��::�::::�'::�...................... � Other Trade's License No. .............................................. /�� _ -�-�Q/ ' � 1. Location of land on which proposed work will be done. Map�No.: .. .. ... . �. .............. Lot No. ........�............ Street and Number � .�..�..��...t�...��._..�..�,.�::::�..... .........-.�............ ..................................... ...... .......... Municipality 2. State existing use and occupancy of p ises and in�ended use and occupancy of proposed construction: a. Exisifiing use and occuponcy .... .....................�..................................... .......................................................... ..... b. Intended use and occupancy '�"'� � ..............K............�..�-�:.. ./..a..................................................................... � , J l � , , . � � i 3. Nature of work (check which applicable): Nevx Building; :................. Addition .................. Alteration ............,. . . � .. Other Work Repair .................. Removal .................. Demolition..........-........ ................................................ ... � d� (Description) 4. Esti mated Cost ...........p�PY C�U...�`........:................'..Fee ..1.5...'.�....................... .................................................. � (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................Number of dwelling units on each floor ....-,..................... Ifgarage, number of c.flrs ............................................................................................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories .....................................................................:........................................... Dimensions of same structure with alterations or ad�itions: Front .................................... Rear ............................ Depth ................................ Height ............................Number of Stories ................................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................., 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Dote of Purchase ........................................................Name of Former Owner ........................................................ 1 1. Zone or use districfi in which premises are situated ..................................................................................................... 12 Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded• ............................ Will excess fill be removed from premises: ( ) Yes ( ) No 14. �dame of Owner of premises .................................................... Address ................................ Phone,No. ...................... Nameoi= Architect .............................................................. Address ................................ •Phone� No. ...................... . Nci��e of Contractor ............................................................ Address ................................ Phone No. ...................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whetner existing or proposed, and indicate all set-back dimensions from property lines. Give street and blocic number or description according to deed, and show street names and indicate �vhether interior or corner lot. � ' � � � �°-�-- %�„ � �•��Q�� , ---, r ' �r�?�,�'C?.� i , .� -- -- `�-_1 - • ' S� �t: 1', ' �-__-__�______. _�°�--�� - -.----.-__e.....� �� L�� ,,��f-I'�� s� , ---------�-�_ STATE OF NEW YORI<, t S.S COUNTY OF ................................1 ........................... ... .. ............................................................being duly sworn, deposes and soys that he is tne applicant (Name of individual signing contract') above named. Heis the ................................................................................................................................................................................ (Contracror, ogent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to m�ke and file this application; that all stotements contained in this application ore true to the best of his knowledge and belief; and thar the work will be performed in the manner set forth in the application filed therewith. Sworn to bef re me this ........... . .... day of ...........�' , � ............................ 19.�..! ...... �� ,�_....�.:............ ............................................... NotaryPublic. .................... ......................... Coun#y .. .. .... �'.% (SignaYure of applicant) � G��CI�� E. DAWSUN NOTARY BLIC, St�te of New York No. 52•4643721, Suffolk Count „- Term Expires March 30, 19�G9