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Home My WebLink About3337-z ]KOH~ NO. :~ TO~N OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDtNG FElt. MIT fi.HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9_'3337 Z Permission Is hereby ~ranted to: ............. ~.~.~.~Z. A ,...~.,.~. .............................. ............. ~l~oa~a ~ ..... #.~.,. ............................ at premises loch;ted at ....... ~....~tlM..J~,~O~Ll[..Jt,11t~ ..................................................................... ................. , .......................... i .......... .~G~QL'~.....I[,~ .................................................................. pursuan~ to application dated ........ ?,:.~. ..................... ~.....~.~. ......, 19...~, and approved by the Building Inspector'. ,- Building Inspector FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ..... ~.../....~...., 19........ ~' * Approved ........................................ , 19 ........ Permit No................'~ ~ '~ ........ 7 ........~ (Building Insl:~ctor) APPLICATION FOR BUILDING PERMIT ................ .......... INSTRUCTIONS a. Th~s appficat~on must be completely filled in by typewriter or in ink and submitted in duplicate to the Buildin Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets areas, and g~v~ng a detailed description of layout of propertymust be drawn on the diagram which is part of this applicatior c. The work covered by this application may not be commenced before issuance of Building Permit. d Upon approval of th~s application, the Building Inspector will issue a Building Permit to the applicant. Suc permit shall be kept on the premises available for inspection throughout the progress of the work. e. No building shall be occupied ar used in whole or ~n part ~or any purpose whatever until a Certificate of Occupan, shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the ~ssuance of a Building Permit pursuant to t} Building Zone Ordinance of the -['own of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe~ 'i'he apphcant agrees to comply with all apphcable laws, ordinances, building code and regulations. (Signa ureo app ic~nt, or name, if a corporation) (Address of applicant) State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or buildc owner Name of owner of premises ....... ~..t:.~.]...e...~....G..:.....~.~.?..e. ....................................................................................................... If apphcant ~s a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on wh,ch proposed work will be done. Map No ............. ...'~... ........ ~ .......... Lot No: ..~.....~..... Street and Number /V'/~u~J ~.~oi~/c~/,,/4~ ..~.. c/'~-~ ~CkO ~ Municipality 2. State ex~stmg use and occupancy of premises and intended use and occupancy of proposed construction: bat~ng beach a Existing use and ~cupancy .............................................................................................................................. b Intended use and occupancy, bathing beach and bath house X 3 Nature of work (check which applicable). New Building .................. Addition ................. Alteration ............... Repair .................... Removal .................... Demohtion .................... Other Work (Describe) .................................... two thousand dollars 4 Estimated Cost ............................................................ Fee ........................................................................................ (to be pa~d on filing th~s application) 5. if dwelhng, number of dwelhng units ............................ Number of dwelling umts on each floor .......................... If garage, number of cars ......................................................................................................................................... 6 If business, commercial or mixed occupancy, spec,fy nature and extent of each type of use ............................. 7. D~mens~ons of ex~sting structures, if any' Front .......................... Rear .......................... Depth .......................... Height ........................... Number of Stories ............................................................................................................. D~mens,ons of same structure w~th alterations or additions: Front ................................ Rear .............................. Depth ............................. Height ............................. Number of Stories ........................................ 8 D~mensions of entire new construction: Front ......... .'9~.CD .......... Rear ........ ,~a..~ ............ Depth ...~m..~ ............... Hmght ............................ Number of Stories .... ~.. 9 Size of lot: Front ....1...0..5..~.t. ............. Rear ...9...0...~..t. .............. Depth ..l.~(}/....~.O.O...i.l;.... 10 Date of Purchasea..9..q.:....b..~....w...i..1..1.. ..... .A...L!~.:....1...9..5...8..Name of Former Owner ...C..o...r.?...t...n..e.....B..:....g...a..s...e. ............... 11. Zone or use district in which prem,ses are s,tuated ........ ',~..*. ........ ~...~-Q__~.. .......................................... 12. Does proposed construction violate any zoning law, ordinance or regulation;~ .... ..n..o. .......................................... 13 Name of Owner of premises ~.t...a..zl...1..e.~....g.,....C~JL~.f~....Address lt~.i,ll..l~.cl.,...~_,l.l.t.a~ag~e. Phone Name of Architect ........... ..s..a..m...e. ................................. Address ............................................ Phone No .................. Name of Contractor .................................................... Address ............................................ I~hone No .................. PLOT DIAGRAM Locate clearly and d~stinctly all buildings, whether ex~sting or proposed, and indicate all set-back dimensions fro property lines. Give street and block numbers or descnpt~on according to deed, and show street names and ~nd~ca whether interior or corner lot. STATE OF NEW_~/'O~ COUNTY OF ............... / ~ '/'~ '~~~.~. ~" C'c~-'~'~ be ng duly sworn, deposes and says that he is the opplk (Name of individual s~~t~on)' ' ' ,~¢~_~_~ ~ _ above named. He ~s the ................................................................................................................................................... ~ (Contractor, agent, corporate officer, etc.) of'smd owner or owners, and is duly authorized to perform or have performed the sa~d work and to make and th~s apphcat~on; that all statements contained in this apphcat~on are true to the best of his knowledge and be and that the work will be performed in the manner set forth ~n the apphcat~on filed therewith. Sworn to before me th~s . ...................... '"'i ........... ......... %W '"' ......... Notary PubJ,c, ....~..t.k¥~.;.% ........ ,...~'.~f.~..f....~..: .... C%unt,y , ~ , (Sig ature ~f applicant)