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Home My WebLink About9713-Z FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N.. Y. , " "A/L) BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ° 9 713 Z Date .....................................A / / Permission is hereby granted to: '!�''IG SOU i NOLO FI`E L1-s—k 7 ................................................................................ ................................................................................ ................................................................................................................................................................. at premises located at - ....1.3 5 f-\ i �01 , ....5 1, ............................................................ S0 U 7 �-) U 9 (\f, y . ................................................................................ ................................................................................ ................................................................................................................................................................. pursuant to application dated .............................................1 ................................... .............. .. 19...� ., and approved by the Building Inspector. lv Fee $........................ /,f 00- 0 -1- ...........................................�................................. BuildingInspector .�rAIS PCC-T! 6 A FORM NO. Y TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERICS OFFICE N SOUTHOLD, N. Y. Examined .....................2121?ll.....L, 19.... Application No. ..`/:. . 3.......... Approved ..................... .... '1 19-Y Permit No. .................................... Disapproved a/c . ........................................................ �.............. ........................................ ............/>...: .. ...:..: ....A.......................... (Building Inspector) A APPLICATION FOR BUILDING PERMIT C Date ......................./. . ......, . ., 19.. �1 INSTRUCTIONS b I1I^ v! a. This application must be completely filled in by typewriter ort 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 Q) 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 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 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, 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 necessary inspections. �I.l..fl.4.f1. ....... ....................... (Signature of applicant, or name, if a corporation) (Address of applicant) o, State whether applicant is owner, lessee, agent, architect, engineer, eneral contractor electrician, plumber or builder. .................................................................................................................................................................................................. Name of owner of premises ........... JV.ti7. h.41%.d...... `. .......��!S.fy I.C. ............................................................. If applicant is a corporate, signature of duly authorized officer. .............................. (Name and tir of corporate officer) Builder's License No. ............ ............................. I Plumber's License No. ................................................ I Electrician's License No. ............................................ OtherTrade's License No. .............................................. 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No. ........................ Streetand Number .................................................................................................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ................................................................................................................................ bIntended use and occupancy .............5.7"a.r...a,.fA-0.......................................................................................... 3. Nature of work (check which applicable): New Building .....X........ Addition .................. Alteration .............. Removal Demolition Other Work ................................................ .... Repair .................. .................... (Description) 4. Estimated Cost ............ ...20�..............................Fee ........... e..Q. ...a.......................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ................ ..........Number of dwelling units on each floor ....•....................... Ifgarage, number of cars .............�,✓..`. v.....c j I-Q.�.9pee........................................................................ 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 .........2r............A�..z-,g... . ..................................................... Dimensions of some structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................Number of Stories ................................ 8. Dimensions of entire new construction: Front ........, .................. Rear ......:.2..Y................ Depth .tea................. Height .................... Number of Stories ..................................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 16. Date of Purchase ........................................................Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated .................... •••••A/•a•r•5:................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .......//.O.......................................... 13. Will lot be regraded .........A,/9............. Will excess fill be removed from premises: ( ) Yes No 14. Name of Owner of premises ... Address .&qtAn.kid.......... Phone No. Nameof Architect .............................................................. Address ................................ Phone No. ...................... Nome of Contractor.SoLJxak� /.... ................. Address ........ Phone No. ZASE..AA0.. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate 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. Cr STATE OF NEW YORK, i COUNTY OF .... .........jS.S ........................ being duly sworn, deposes and says that he is the applicant (Name of individua signing contract) above named. Heis 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 application; that all statements contained in this application are 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 before me this .......... ....... day of .......Z?� y 19 Notary Public, ... . . C�.`!f srrn........ County .......3 . - .......... ..................... ...... (Signature of=applicant) -MURIER tt`:FUSH NOTARY PUBLIC State of I\cwYor� FORK NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERIC'S OFFICE SOUTHOLD, N. Y. A ..,.... / . Examined ..................... �..... 197..... Application No. ......... .. Approved ...................../°1. �......� 19.7tPermit No. .../. �,. ... Disapproveda/c ............................ ........... ......................................... ........................................................................................................................ .......1. . ... ........................ (Building Inspector) APPLICATION FOR BUILDING; PERMIT Date ...................... v l. .... .. ., 19...:.."...... INSTRUCTIONS a. This application must be completely filled in by typewriter oe 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 of 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 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 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, 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 necessary inspections. spn,.....� . ..`.................. (Signature of applicant, or name, if a corporation) cs. P:.Y....4V.:e .. .......................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor electrician, plumber or builder. .................................................................................................................................................................................................. Name of owner of premises &?. th1.a)-.G(. .11�^.,e... .,D./.S.4--Z.C.rz......................................................6................. If applicant is a, corporate, signature of duly authorized officer. ....�%..... :. ./l: I ..:. ........ .. ..... .. ...... .... (Name an title of corporate officer) Builder's License No. ......z.��..��.�.....................6.............. Plumber's License No. ................................................ Electrician's License No. ............................................ Other Trade's License No. .............................................. 1. Location of land on which proposed work will be d9pe. Ma No.: .......... .......... ....... Lot No. ........................ Streetand Number �L S,�.... �....�,. ............................6........... ......... ..6...................... .................... . . . Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy .................................:.............................................................................................. b. Intended use and occupancy ....... ................................................................................................. 3. Nature of work (check which applicable). New Building ...:.............. Addition .................. Alteration ................ . Repair . Removal Demolition.................... Other Work ................................................ .... (Description) 4. Estimated Cost ...........Y.7.d.0...............................Fee ......:....... 13.. ............................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................Number of dwelling units on each floor ............................ Ifgarage, number of cars ................. G(......V-t��.r .....5T.o. y.Q�:-e�....................................................................... 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 .............. ./. ........IZr,, ;.......................................................... Dimensions of some structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................Number of Stories ................................ .. / i 8. Dimensions of entire new construction: Front .............o?`f................ Rear ......�.5r............... 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 .............'k........... Will excess fill be removed from premises: ( ) Yes (}C) No 14. Name of Owner of premises 4u.fji.c�Z.�i f- ..Ql•S k/fit Address-SacrXa.,.d............ Phone No. Nameof Architect .............................................................. Address ................................ Phone No. ...................... Name of Contractor ............ Address� ........ Phone PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate 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. s~i 30 s' STATE OF NEW YORK t COUNTY OF ....-?u,f„ .v ��........I S.S .q. Sf .t�.... J-�cS.s............................being duly sworn, deposes and says that he is the applicant (Name of individukaI signing contract) above named. Heis the .......................... ..-................ - ................................................................. (Contractor, agen'r corporate officer, tc.) 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 contained in this application are true to the best of his knowledge and belief; and than the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ............/........... day of ... !<!�.-ic..f.................... 19.�e . .�. •��. Notary Public, / County .. .1 ..:........................... (Signature,/of applicant) MURIEL. BRUSH NOTARY PUBLIC, State of New Yoeli No. 52-4522026 - Suffolk County Commission Expires March 30, 19.....:.�— �., "'"�" r i'..'r---}-""�'".'e'R•r'--^e�+++y,r^h,, •-- ,...,-.,, a..-,+�. _.. ,a...-+r• w*.". _ : - - —___.. �T—____ - __ ----,,,,. . - a. -r .. _ . , _ . . , ,.,., ,. . k .. _-`--7-'i�`�':,y�T {{ f .. 44 1 ♦ d .( ^ - .. - - ., I .w... .....•r,.w.,.•w....•w.•..-.ro:Yun.r+....w,w+....�wwrs.w.r+viv...-..:.r»..•„n+.......:n�•.-rw+.,--..—,•OJr.sao,.•..,,....«w.re,.w„i.a...u'�.�wM.rw...'W_YewrwY.+w.R..w.'^wn.+n.l+...e+!�w ..K+zrerw.+aw..�.., ++*i..'.sw ie+n+,.,.v.r. ....w.. _ ...'....i+r,.w - s < * „a .�...++....s.. .+,............+.. r yI .3 r, - •r..n+�+.w+e..^•'o'T... ,....._.+..,..-,_+r.+,r+wr..,�»+...-._�._.` _.�-.•,-,..�.n. . l •r.t F,A. _ - _ '..� a.'` . - , ..w•�+.s.+ •„r+...a.+a�Y?'/w.w.�.w+irr*V,wr+..si�. .,....,.... „ - f(R,. , ' "� _.rin+rrr++4.+,.."rr.M,�w••e'.+wN+.4.�w.M+..w.M•.•wr..•.-.n-»-._..rr,..r.-.. __ c ,1w !. . " /�,+� . 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