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Home My WebLink About1534-zTOWN OF SOuTHOLD BUILD NG 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°. 1534, Z Date ...................... A~I.~.~. ....... 2.9. ......... lg~... Permission is hereby granted to: .,. H~.~m...~io..~.~¥~..o.m ................................... .... ?.~l......ff.c)t~..S.t ............................................... ....... t~.o~kZ~z~......N~.Yo ...................................... to ....B~ild.. a.. ne.~...oae.. £amily....dw~.lling .............................................................................. at premises located at .~/~.....-~t~r..~...~a~e......(.Nf~d~..O~,.~.o.) ....... ,LC).~..~.~.t,..~J,..~...~.2.. ................................................... ~ eu¢-.ho.14 ......................................................................................... pursuant to application dated ............................ ~t~.~e ....... .~ ................. 10~1~..., and approved by the Building Inspector Building FOEM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, H. Y. Examined .......... ...~...~. ...... Approved ......... ~,~2;..,,~.g....~.'.~LPerm~t~,~ ~_,,~.. *~.N°' ,~.~.~ ........ Disopproved a~c ...~..~..~,~~ .............. ...... ............. .................. (Building Inspe~ Application No..../.~.~.. APPLICATION FOR BUILDING PERMIT Date ....................... ~....?.,. ............ 19...,~..../.... 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-o detailed description of layout of property must. be drawn on the diagram which is port of this Jocotion. c. The work coYered by this application may not be commenced before ~ssuonce 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 Certificate of Occupancy shall hove been granted by the Building Inspector. APPLICATION IS HEP, EBY 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) ...... s (Address ofrapplicant) // State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises......~..,,.,-~..~x~T" ......... .......................................................... If applicant is a corporate, signature of ddl~ authoriz~cl officer. ..... : .............. ~"~i"~i~i~' ~"~'~'~'~'~¥~"~¥~'~;~i ................... 1. StreetL~ati°n of land on which preposed work will be and NUmber ...~~.:~)....~~',~ 2 State existing use and ~cu~ncy of p~m ~s and intended uFe and ~cupa~y of propo~d C~st u~on: ~. ~xi~,,,~u~ean~o~u,~.....:..~~:., ...... ~ ......... + ............ : ................. ,.~"." ................ ~. ,n,e~,., .~e ~.~ ~u,~.,,......~...~~ ................................ : .............. ' ........... property lines. Give whether interior 3. Nature of work (check which applicable): New Building .................... Addition ....; ............... Alteration .................... Repair .................... _R~moval .................... Demolition ............. , ...... (~eJL-Work (Descr be) 4. Estimated Cost ...........7~.~..~.~..: ............................... Fee .."..~./.~...~ ................................................. . (to be pa d on fil ng this appliCation) ' 5. If dwelling, number of dwelling units ........~ ...... .....Number of dwelling units on each floor ............................ If garage, .number of cars ........................................................................................................................................ 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 .. ............................. Numbejr Of Stories ................................ 8. Dimensions of entire new constrUctior~: Front.....~...~.. Rear ~...L ' Depth ....~....'~... ............. Height ............................ Numb6r of Stories 9. Sze of lot Front../~..- aear De th 10. Date of Purchase ..~.'~.'.'..~'~.......~;"'.~i./,~,~...Na'm'~"~f,F°rm~i'%wnr/er ..' "'~.'"~....~..~'7/';"~'-'" ~"~- ';~x'"' P ac'~"/~'""" ' ' '~ ........ Zone or use district in Which premises are situated ........ F/../:...../.~,: ~ ~;4~,~ ............ i .................... 11. 12. Does proposed construction violate any ~-.o, ning law, ordinance or 'regulatJon? ".....~ ........ 13. Name of Owner of premi~se~ ~.'?Y..~.,~.~Address ~~,~..Phone NO. Name of Architect..';~-,t~' ~...~...~..~/~. Addres,~'....*~.,~... ~..'~,~/,...,1~, ~,~ Phone NO~. - Name of Contractor .... .~.......?v~/~.~... '" ' -~ //~/ * ~ ~ ~'' ' PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate all set-back dimensions from names and indicate street and block numbers or description according.to deed, and show streej' corner lot. /~"01 I¢ STATE OF NEW )~)~,./~/ ) S S ' COUNTY OF ..~a~W-a~::~._..) ' .............. ........ ~.C~.~:' ...... ,;;.~...~d:~:~..~.. ......... being duly sworn, deposes and says that he is the applicant (Name of indi~ua! sign~ applicati~) .......... .......................................... : . (Contract, agent, co~orate office~, etc.) of said owner °r ownem, and is duly au~on~d to ~rform or have pe~ormed the smd ~rk and to make and file this application; that all statements ~ntai~'in this applicafi~ are tr~ ~:~e ~st of his ~ledge and belief; and that the work will be perfbrmed m the ~er set fo~h in t~licati~:filed the~ith. Sworn to ~f~e me this ......... ....... ......... .ot ,ub,i