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Home My WebLink About1338-zTOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS F~ERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 1338 z Permission is hereby granted to: c~t premises located at I~.S...pr.J,.V,1~..Z'.Q~.~..~D,Q~,..~..~..~..~.~.....S..O...~.~. ................. .................................... ~/. ~.. ~ ~ ..~.~,.e.~.. Ro.~ ~ ......................................................................... .................................... ..~. ~...~.o.:.....4....o.m...~..~.....o.~..~.~...q~.e...e.~...~?...v.~..z.?~.~ ....................... pursuant to application dated ............................... -1~1~¢1~..~-~ ............. 196~..., and approved by the Building Inspector Fee $.lO.,.O0...~)t pai~ ......Building :': ............................................... Inspector 2'1 FORI~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLO, N. Y. Approved .......... ~ ....... LC.......~19 ........ Permit . ~.' ..v4x,~..~ .~...~... .... .............. ............... APPLICATION FOR BUILDING PERMIT 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 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 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 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 B~ilding Department for the issuanc.e 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 and regulations. . /' (Signature of applicant, or name, if orporation) ....... ............................................. (Address of applicant) State wheth.er applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ............ .'rT..~.e...~...~?.....l~...e.~.~.y. ....................................................................................................... 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. MaD No: .~.~.t:....~.e.~..~.e...~..°....~r~j~o: ..... ~ ............. Street and Number ~../.~v~a~t:.e.~.~..a.~.~"~.%~..~~..a.~.e.~f~.8..~.~.t-.~.~..~.~ ....................................... n/s Ila:l,n Bay :t.ew Rtl. Municipality 2. State existing use and occupancy of p~emises and intended use and occupancy of proposed construction: a. Existing use and occupancy VaC~Mlt: ,1,Or; One £am:Ll¥ dwelling b. Intended use and occupancy ................................................................................................................................ 3. Nature of work (check which applicable): New Building....~XX .......... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost..~..3.:~..O...0.0..*...0..O....~ .................................. Fee ....{Jl.~.:.O..O. ........................................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ......... ~ ..................... Number of dwelling units on each floor ............................ If garage, number of cars ................. ..~..O.~.~. ................................................................................................................. 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 ................................ Fr $0 Rear 30 Depth 40 8. Dimensions of entire new construction: ant .................................................................................... Height ............................ Number of Stories 9. Size of lot: Front .... .~.0. ................... Rear .._7..0. ................... Depth ..~,.~.~./~.~.~. ......... 10. Date of Purchase ............... .~..9.~. ............................... Name of Former Owner ...~..~..~....~..~.t'.....Pt..O...!.?~.~....~.~. ........... 11. Zone or use district in which premises are ...................................................... ~ ............................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ................ .lt,..O. ............................... 13. Name of Owner of premlses..~....t~l....~.~...~..*....~..~.~.~,....Address ..... ..~..O.~.O..1...~. ................... Phone NO ..................... Name of Architect ........................................................ Address ............................................ Phone NO ..................... ... . ,TamolJ ~, Kell~ ,,, I8ou~hold .., ............................................ ~none NO. . Name of ~_onrrac~or .................................................... ^aaress .................... 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. W STATE OF NEW~,.¥~I~I~e~ ) S S. COUNTY OF ............................ ) ............................. ~..~.~.4~ ................................. being duly sworn, deposes and says that he is the epplicant (Name of individual signing application) above named. He s the.. (Contractor, agent, corporate officer, etc.) of s¢id owner or owners, and is duly authorzed to perform or have performed the said work and to make ~nd file this application; that a ~}atements conta ned in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therew th. Sworn to before me this ~ g~ ~UD~ T, ~OK[N 27~ 4 ~f ..... , ........... 19 ~ Public, State of New YorKSignature of applicont) ~