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Home My WebLink About3975-zTO~N OF $OUTHOLD BUILDING D~:PART~I:NT TO~N ~LERK~$ OI:FI~ SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 3975 Z Permission is hereby granted to: .... at premises located at ...,Jda.~..ll~...2 ....... ~J~lJ~....~..~..:J~...l~. ................................................................. ........................... ]l~..A~..&..lap~..llit ............. .~t~l~.eae ..................................................... pursuan¢ to application dated ............................ eT.13~ ....... ~10 .......... , 19..l~lt~., and approved by the Building Inspector. FORM NO, I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, Y. Examined ...... ['i ............ , 19 .... " N .3J75 7 . Approved ........................................ , 19 ........ Permit o ............................. Disapproved a/c ................................................................. ~... ' ................................................................ 2T....7~. ........................................ ................................. 'fff~,¥i~';~'&' 'i;~;~';;;i ................................. Application _~?7F APPLICATION FOR BUILDING PERMIT '*-// ~o Date ....... ./.... .............................................. , 19..~..Z .... 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 detai ed description of layout of property must be drawn on the diagram which is part 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 shah 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 comply with all applicable to laws, ordinance~t~uilding code, housing~eode,~d regulations. .'..'.'.'.'.' .'....'.'.' ..... (Address of applicant) State whetb~z~j~plic~Dt is, ow~ner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................................. ...... .......... ........................................... ...... ; ..................................................... Name of owner of premises .................................................................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) ' Lot o ]. Location of [and o. whJcl'~prg~t3sed ]6~.l~rk ~,ll b.elsJ~one...~Aap No.: / ~/~-~_~'.~ ~/Z~,~~ C ~ ' ~' '~/'~ ~..Z ~,,Z~. --' ~-- r,_,~,~,4/.£/~ ~.,f,,~//~: ....................... ,f .............N .: ................... Street and Number ..................................................................................................................................................... Municipality 2. State existing use and occupancy of prem~,0s~a~d-intended use and occupancy of proposed construction: o. Existing use and occupancy ~..~ b. Intended use and occupancy ................................................................................................................................. 3. Nature of work (check which applicable): New BL]ilding .................. Addition .................. Alteration .................. Repair .................. J~e~ov~al ....~)~ .......... Demolition .................. Other Work (Describe) ........................................ ,/~. .~ ~'~ -.-- 4. Estimated Cost ...........d ............................................... Fee ........................................................................................ .. / (to be paid on filing this application) 5. If dwelling, number of dwelling units ....~ .......... ~......~um~er 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 olterations or additions: Front .................................... Rear ............................ Depth ................................ Height ..................... .~.~m~r,~f Stories ................................ 8. Dimensions of entire new construction: Front ..~...~ ....................... Rear ............................ D~th ........................ Height .................. 7~er of Stories ...... 7.~.~..~.t. ........................................................................................ 9. Size of lot: Front ..... ~ ....... Rear .................................... Depth .................... 7.~..~ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district Jn which premises are situated ..................................................................................................... 12. Does proposed construction vio~e ~ zoni~g~w, ordnance or reaulat~ . .,~ ~ ~ ~ c~gazl~ . ~ ~71 ~'~ .............................................. 13. Name of Owner of premises ........................................ Address ..................................... : ...... Phone No ..................... Name of Architec~ .................. ~...~......~.~...Address Contr~ctZ~.....~..~..~...Address "~'~'~ ....... P~ne ~o. ~ome of ........................................... P~ne ~o ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, ond indicate ail set-b~ck dimensions from property lines. Give street ond block number or description according to deed, ond show street nomes and indicate whether interior or corner lot. STATE OF NEW )~j~.l~/~_ t c c COUNTY OF, ......'TTT...JJ.. ~ ~.'..~,,,,... ,f ~;~' ................................................................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing applicat~) ~bove n~med. He is the ......................................................................................................................................................... (Contrector, egent, corporete officer, etc,) of s~id owner or owners, ond is duly ~uthorized to per~orm or h~ve performed the sold work ond to moke end file this oppiic~tion; thor oll statements contained in ~his opp!ic~tion ~re true to the best of his knowledge ond belief; ~nd t~"~r ?~-w° rL- ~ '~ I)-~ r fO r reed~--~ --~o ~ m.uu~ i~the ~m? nner set ~orth ............... o, ........... ............... , Notary Publi~~~~~~"r"'(S~';'oture of opplican;)