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Home My WebLink About3802-z FOR~ NO, 2 · TOWN OF soUTHOLD BUILDING DEPARTMENT .TOWN CLERK'S SOUTHOLD, N.Y. BUILDING PERMIT N? (THIS PERMIT MUST BE KEPT ON THE pREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 3802 'Z Dote .......... Permission is hereby granted to: ............... ~..~.~.~:...,~. ............ :i ................. ............... 1~ ..~a;g...~;L~'~ ................................. ......................... :La~'~a...: .................... :L., ........... to .. ~b:J.;L~, ~.~f~ e~m:~,:..~ ................................................... ,,..., ............................ at pr~mises located at ~/~....~.~0~;~..~..1~1~1t~ ............................................... ....... : ................... ................. : ............. l~e.'a~.L ...... ~.~.X. .................................................................................................. pursuan,t~ tq application dated .......................... J~4~l~.e..~ ................. , 19~j,.., and ,approved by the Building Inspector. TOWN OF SouTHoLD BUILDING DEPARTMENT/~. TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved '' 19....:~.. Permit No...~...~..Q.~...~- Disapproved a/c ..]~ .................. ......................... .... Application iNo ....................... APPLICATION FOP. 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 p[emises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property mast be drawn on the diagram which is part of this application. c. The work covered by this application may not be corr~menced 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 wo'rk. e. No building shall be occupied or used in whole or in part for any purpose whatever until o 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 f~, comply with all applicable laws, ordinances, building code, housing code, and regulations. ~ i ~, (Signature of applicant, or name, if a corporation) '(Address of applicant) State whether applJca~3t is owner, lessee, agent, architect, engJ.neer, generol ,6ontractor, electrician, plumber or builder. Name of owner of ~bremises /' If applicant is a ~brporate, signature of duly authorized officer. / (Na~e and title of corporate officer) 1. Locat~od of land on which proposed work wdl be done..Map No.: ~ ................................... Lot No. ,,,,~ ................... /~ " Munic pality 2. State e~st~r~g use and occupancy of premises and ~ntendedi ~se and occupancy of proposed construction: Existing use and occupancy ..... .}3w~.3.~.~t,~ ................... ~ .............................. ~ ....................................................... b. I rJiende~ ~rr / '/ use and occupancy ......... same..'u':t'th'"a~"~% 3. Nature of work (check which applicable): New Building ....]j~ ....... .Additidn .................. Alteration .................. Repair ..................Removal .................. Demolition .................. afl'er Work (Describe) ........................................ 4. Estimated Cost ..~.~/('~':'~ ~ Fee Ct' o be. paid on filing this al~plication) .5. If dwelling, number of dwelling units ....... ~O~e ........... Number of dwglling units on each tiger ............................ If g age b f ar ~ num er o cars ......................................................... .................................................................................... If business, commercial or mixed occupancy, specify nature and exten~ of each type of Use ............................ 7. Dimensions of existing structures, if any: Front ............................ Rear ' ......... t ...................... Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with o.lterations or additions: Front ........... ~ ........... ; ............ Rear ............................ Depth ................................Height ............................Number of Stories 8. Dimensions of entire new construction: Front ....... ~J8 .......... ; ............. Rear ......'..~J,8;;;.?! .......... Depth ......... 50 .......... Height Number of Stories ' ' 9. Size of lot: Front '"100 ................. Rear ..........tOO ...................Depth ...,~jCr..~/...~,.0 ....... 10. Date of Purchase ........................................................Name bf Former Owner ........................................................ 11. Zone or use district in which premises are situated ...... i~:&~l"'~J~8'~ ........................................................................... 12. Does proposed construction violate any zoning law, ordinance qr regulation? ............. ~...~ ...................................... 13. Name of Owner of premises ...l~,,~.t,¢~-..~.$~te:~ ........ Address '"[¢z~'~'~"" ....................... Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .......... 6.~mG ................................ Address ..................................... : ...... Phone No ..................... PLOT DIAGRAM ' Locate clearly and distinctly ail buildings, whether existing or proposed, and indicate~ all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. / STATE OF NEW YORK, ~S S ......................... -..i......}4~$'.~;,~t~,...~.i,f~e~ ................................. be{i~n'~ ~uly sworn~,~eposes and' , ' " says that he is lhe, applicant (Name'f)f individual signing application) i -- abow~ named, kiel is the ...................... ~,¢'~ .................. ~ ............ ! ........................................................................................ ~ (Contractor, agent, corporate officer, etc.) of said own;er or owners, and is duly authorized to perform or Have performed the said work and to make and file this application; that all statements contained in this application' ore true to the best of his knowledge and belief; and that d~e wo'rk will be performed in the manner set forth in the application filed therewith. Swam to before me this · ,: . ...-¥ ,., . . ' ...... ............................ Notary ~ubli¢, ...[:¥.~.~...i,.{..~...i.t.~..i BAm0N /x t~C,C~I ~ County , , (Signature or appucon~)' NOTARY PUB, lC. State of, f,~oWu ~rifkJ / " ' No. 52-3233120 Su el./ m~ ' ! Term Expires Ntarch