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Home My WebLink About3074-z FORM NO. I ,.Vq~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Applicotion No....~....~..~...~.~f. ............ APPLICATION FOR BUILDING PERMIT Date ........................... ~ ..........~ .............. . 19...~..6. ...... 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 port 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 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 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 and regulations. Rev. John Jefferson.J~.a..Cllu~cl~..c~...G~d..~..ab~.~ai; ............................. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. JLge~.. ~£... Chur. ol~..a~ see .t&t.t.o~ ................................................................................ Nome of owner of premises ....... Ch~.a.h..~£..~l...~.n..~h~t ..................................................................................... 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. Map No.: ........ ~ ..................... i...' Lot I~lo.: .~ .................. Street and Number ....... ~.~.,..~[~l. dle..~Jo~J~.,....a~J~.t.~l~ok .................. : .................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ............. .~.&~.&D,t~..,],tL~ ........................................................................................... b. Intended use and occupancy ................. ~ll...~m4 ].~'...rt-ele.~l~ ................................................................... 3. Nature of work (check which applicable): New Building .... ..~.[ ........ Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ..mOt/*~.~,,l~o~~ ......... 4. Estimated Cost ............................................................ Fee ....~.g. Jfl~ ............................................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ............ JJl~, ........ 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 ....... 2. Q ............... Rear ......... :PO. ................. Depth2:p ................. Height ........................ Number of Stories ..... .t¢..~.9. ..................................................................................................... Dimensions of same structure with alterations or additions: Front .................................... Rear ........................... Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ..... ~1.~. ............... Rear .................. :[2,.9. .......... Depth ....,3.~...J~/~J, .......... 10. Date of Purchase ........................................................ Name of For~ne~ Owner ........................................................ ! I. Zone or use district in which premises are situated ....... !!A."....cll8:L .......................................................................... 12. Does proposed constr~ction violate any zoning la~, ordinance or regulation? ............................................................ 13. Name of Owner of premises ...... g]33Z~..l~h...O~...Cho~l,..~d~Jl~.1.tl~ ...... .[~a.t,t;.~.t;ll~-k ..... Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .~J.e.~...nT..~P....~e,J'.~.~.O, rL ...... Address ........... J~a.:lLt,:L~g.e~ ........... Phone No ..................... PLOT DIAGRAM Lac-,-4e clearly and distinctly ~li b~iklings, whether existing or proposed, and ind~,e ~1 set-b~k dim~nsi~s ~(.~ property lines. Give st~eet and block number or de~ription ocaording to deed. and ~ ~eet .name~ and indicate whether interior or comer tot. STATE OF NEW YORK, I = = COUNTY ........... ................. ~O]:~..~e,J'~l:t~li, ............................................. bei.ng duly sworn, -depose, and says that J~e is the ,q, ckolicant (Name of individudl, signir~g opprJicotion) above named. He is the ......... ~eD.t,..J:::~...et~l~J:~,&...O. lJzl'l ..CoJ~,e,.zta,e,f,~. ............................................................... (Contractor, agent, coq~orate officer, etc.) of said owner or owners, and is duly ,authorized to perform or have perfomned the ~oid work end to ,make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manna/~et forth 'in the oppltcation' filed therewith. . Swam to ~re rna this ' -~~. FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERIC'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 3074 Z Permission is hereby granted to: ........ .~ ~ .~.e..,.. ~,t ~¢~ ............................................. ............. I~ .~ti.tuck~...~.o.~.. ............................... to ...N~ov~..~.. ~x& ~.~i~{f.. ~fe~ .~.~.~... ¢,~..~e~,~...~ee a.~ .~en ....................................................... at premises located at ...]f[/~.....~$~]d.le...R~d .............................................. J ...................................... .................................. ~a.~t Ltu~k~......~ :~, ......................................................................................... pursuont to opplicotion doted ........................ ~%~L~. ......... .~. ................. 19.~**, ond opproved by the Building Inspector Fee $ .l'l~t~.. ...........