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Home My WebLink About4107-z FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMEN~ TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 4107 Z Permission is hereby granted to: ...... ~4~t~:.~o..a~J~ ................. ~ ................. ........ ~t~tuel~r. Jlo~. ................. ; ................. to . ~ .;~....a..?.m .~.a..~ ...~.;~....a. ~.*..~.~ ....................... J .......................................................... at premises located at ..... [/.[..J~idJ.~JaJa..~...~,~ll, ........................ .......................................................... ......................................... ~'M.t :~;i,~c~t...~,~L. ........................ ~ .......................................................... pursuan,t to application doted .............................. Ot~t ......... ~..;...,., 19.~.., and approved by the Building Inspector. Fee $1-0-,,.00. ............ ' ~ Building inspector ~ NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y, " ., ..4. Approved .................................... , 19 ........ Permit No .................. Disapproved o/c ........................................................................................... ....................... ............................ APPLICATION FOR BUILDING PERMIT Date .............................. . .O~....t~....1~..~..~..8......., 1 ~...~..~. 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 g v ng 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 Bu.ilding .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 pu~.ose 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 lows, ordinances and regulations. (Signature or appficant, or name, if (Ycorpora ion/ (Address of applicant) · State whether applicant is owner, lessee, agent, architect, engineer~ general contractor, electrician, plumber or builder. vte or a. Name of owner of pr mlses .................................................................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate of *cer) 1. Location of land on which propOSed work will be done. Map No: ............................................ Lot No: .................... Street 'end Number ..... ..l~..~...I~...e.~.'.~..i..l~..~..~;..'.~..~..~e~...~......l~.....J~.:~.. ........................... i .................. :t...,..; ..................... Municipality 2. State existing use and occupancy.o~, premises and intended use and occupancy of proposed construction: a. Existing u~ and occupancy ....... ~ ............................................................................... ',.. ........................ b. Intended use and occupancy . ...~.....I~..SlI~ Xet, .~...w...~...(.~.c~..~...~..~.~.~...~..~.)....~..~...~..~...~..~.../~../..~.~...~~ ......... 3. Nature of work (check which applicable): New Building ....... ..~. .......... Addition .................... Alteratlon,*...i .............. Repa r .... Removal Demo ti~n "' Other Work ~1~ 4 Est mated Cost ..~...~000.00 , F~--' ~.0o00 ~f ; If dwelling, number of dwelling un ts 01~ (X}-....Number (to be paid on filing this application) ..................... of dwelling units on each floor ................... 10. 11. 12. q3. ar If garage, number of c s ..................................... ............. : .......................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ................................ 7. Dimensions of existing structures, if any: Front. ....l~....z~.. ....... Re ar ............................ Depth ................................ Height ............................ Number of Stories ............................................................................................................. Dimensions of same structure with alterations or additions: Front ~1o~ Rear Depth ................................ Height ................................ Number of Stories ................................ 8. Dimens ons of entire new construction: Front 75 feet, Rear ?~ feet, Depth 33 feet, Height ...... ..1~....~ ........ Number,of Stories.......0~......(...1'..) .............. Size of lot: Front ...... ~.~..~.~...~..'. Rear ......]..'~..~....~..~....t, ........ Depth ....... ~?.~...f..e?~ ..... Zone or use district in which premises are situated .... ..1~..~..1~..~ A Does proposed construction violate any zoning law, ordinance r u' "n-- Name of ~rchjt~ct .... ..Z~...I...t~....r..~ll Address ~ Yorlr,~ ~ Yoz~; PLOT DIAGPu~M 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. _ I STATE ~)F N~ yO~..._ ) S.S. COUNTY OF ........ ~...) ................................................................................................. being duly deposes and says that he is the applicant (Name of individual signing application) ~$ : sworn, above named. He is the ..... .0..o..?~ e~ 0~l~z' ~'~t4 ~e'm'lle~; ~ ~ ~tractor, agent, corporate. ~,"~.~' ....................................... cT%%;3%%7.TC,-~7~,T~[, and is duly authorized to pe~rm or have ~rformed the said work and to make and file this application; that all statements c~tained in th~pplication am tree to the best of his knowl~e and belief; and that the work will be performed in the man~e~t~ojD the aPplicat~ filed therewith. - /,r Sworn to before me th,s -.pu,"~'~:;~"- / / / . ~ ....... ~ ........day of ...... ~t.....~.~,~~ YX~ V. O~r -- W ~ota D ~i ~ ~ff~m,ss~ .~ ~ ,u~, c~ ...... ~j~....~.~.~.~.......~.. County (Signature of a~licant)