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Home My WebLink About325-z ~_i~l~ NO. 2, TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLE~RK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.°, 325' z Pez mission is hereby granted to: Ila~l,e..l~r..o~chuk ...................................... ................. ~. ~..n ~h..st ......................... ............................... lg~.. Zo.rk..9.~.. 1[, Z,~ .......... to .... Zm.tl4..new.4we].,~a ....................................................................................................... at premises located at -~B-o--~l~l;~l~-'l-'~.f:..~...'J~%r ................................................................... pursuant.,' to applicahon dated ............................. ~....~. ................ 19.~.~.., and approved by the Budding I nspector Fee Bu~idmg Inspector /_./?/,vte NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ 19 ........ Permit No ............................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS o. This applicotion must be completely filled in by typewriter or in ink ond submitted in duplicote 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 location. 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 o 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 shall be occupied or used in whole or in part for any purpose whatever until a Certificafe 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 a Iterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineerj general contractor, electrician, plumber or builder. Owner Name of owner of premises........Z~'..~.~....~Jr-e......~.;~D. SP-~3~C~r........; ..................................................................................... If applicant is a corporate, signature of duly authorized officer. XX~ X~XXXXXX~:)~ (Nome and title of corporote officer) 1. L~ation of land on which proposed work will be done. Map No: .~.~.~...~.$.~ ..................... Lot No: .................... Street and Number .....~.~.~.~..A..~.~Ze~,.D~e.~ ........ ~.~.~.$~.....~.,.~.....: ............................... Municipdli~ 2. State existin~'~ ~nd occu~ncy of premises and intended use and occupancy of proposed construction: a. Existing useand occupancy ..................................................................................................................................... b. Intended use and ~cupancy ............... ~.9.~.~.~ ............................................................................................... 3. Nature of work (check which applicable): New Building.....~.. ............ Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............ ..o..~...e. ............ Number of dwelling units on each floor ............................ 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 additions: Front ................................ Rear ................................ Depth .............................. Height .............................. Number of Stories ................................ 8. Dimensions of entire new construction: Front ...... ,R.~..Z'.t .......... Rear ....... ..~.~ ........... Depth .....2.~-.~.~,. ............. Height. ..JP~..~'. ................. Number of Stories ..~1:i~ ................... 9. Size of lot: Front ].].~r.].60 Rear Depth 10. Date of Purchase ,T~..~?.~..3.,g~ ....................... Name of Former Owner ..~z',..l~.sa~ .................................... ]1. Zone or use district in which premises are s~tuated ........... ,~......~.~l~fl~l:J.~.~. .................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? .................................................... 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 indicate all set-back dimensions from property lines. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW,./',~R~/x ) S S COUNTY OF ...~../...;,~/~ ........... ) ' (Name of ~ndividual signing application) ' ' above named. He is the .............................................. ~~ ................................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owne~, and is duly~~ perform or have performed the said work and to make and file this application; that all statements ~fSi~ ~lication are true to the ~st of his knowledge and belief; and that the work will b~r~'~.~ set forth in the application filed therewith. Swor~ore me t~' ~i~e%°in ,ew ..... Yor' ~' k cou~/' ........................ day bf/.~.....~tgL.~ ......... ~ ............ (S~gnature of apphcant) '~ Noto~ PuN.c, ~4~ Coun~ ~ ~ < ' · ..... ........ ;'"