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Home My WebLink About4511-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLDo N. Y. PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 4511 Z Permission is hereby granted fo: ....... ~ol~;m~..bbo.~.~r,~eft ....:bm ............ ................. #~t~o~l, ...... IbZ~ ........................... to ............ ..a~....e..e..~.....~......~..~...~..~..L~....~;l.~.....~t,..;~..3,~ ...................................... .................. {~nJ~ine~..tn..~ms=~. ~..mttstsns..sz~nn~..ttsn} .................................... at premises located at ............. JJ~....JJ~_t~..~Ji~4J..W~-..~.~4~t..-~.~--~Jj~ ................... Building Inspector. Fee $...~. ~.~. ........... FOR~ li'O. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ....................................... , 19....~.... Permit No ............................ D,sapproved a/c ...:,,,~ ................................... ,..,., .................. .. ......... ,~ .......... ._:......., ........................... (Building Inspector) APPLICAT,ON FOe ~ PE~M,~ Date ..... (~..~..~...~...~Q..~...~......~. ................. , INSTRUCTIONS a. This application must be completely filled ,n by typewriter or in ink and submitted in duplicate to the Budding_ Inspector. b Plot plan showing location of lot and of buildings on premises, relationship to adjoimng premises or public streets o, areas, and giving a detaded description of layout of property must be drawn on the diagram which is part of this application c The work covered by th~s apphcation may not be commenced before issuence of Building Permit. d Upon approval of this application, the Building Inspector wdl issue a Building Permit to the apphcant. Such perm~ 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 Occupanc,~ shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Build,rig Department for the issuance of a Building Permit pursuant to th~ Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o, Regulations, for the construction of buildings, additions or alterations, or for removal or demohtion, as herein described The applicant agrees to comply with all apphcable laws, ordinances, building code, housing code, and regulations ...~ A,.,.,~.~.~.,..,....~k~..c~.~..~..~¢x...X. ,..,.c. ...... (Signature of applicant, or name, if a cbrparation) ....................... i ....... 'k~' .~ ,'a .... ? .............. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or budder .............. k,.~.~,~...C..~,.4x...,..~ ...... .~b.~ .~. c4.~. ~..~.,.e..e, .... ~*~ ~.,e, Name of owner of premises ...................................... ~ ...................................................... If applicant is a corporate, signature of duly authorized officer (N.me end title of corporate officer) 1 Locot,onoflandonwhich~rposedworkw,llbedone MapNo ~ ,~ LotNo ~/ Munici~li~ 2 State existing use and occupancy of premises and intended use and occupancy of propos~ construction' ......................... :.'. ...................................... .............. 3 Nature of work (check which applicable). New Budding .................. Addition ................. Alterat.on . .. Repair .................. Removal .................. Demolihon .................. Other Work (Describe) .................................... 4 Estimated Cost ........................................................ Fee .................................................................................. (to be paid on fihng this application) 5 If dwelling, number of dwelling umts ..........................Number of dwelling umts 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 ex~sting structures, if any: Front .......................... Rear ................................ Depth ................... Height ........................ Number of Stories ............................................................................................................ D~mensions of some structure with alterations or additions' Front .................................. Rear ....................... Depth .............................. Height .......................... Number of Stories ............................... 8 Dimensions of enhre new construchon. Front Rear ............................ Depth ..... ,~. ......... He,ght-,:¢.'..~t~/!..~:. .... Number of Stories ...................................................................... ! 9 S~ze of lot' Front ......... /.'..~...¢?...~. ...... Rear ........... .~.~ ............... Depth ....~.~'~...~.~...~..~ / 10 Date of Purchase ...................................................... Name of Former Owner ............................................... 11. Zone or use district m which premises are situated .......................................................................................... 12 Does proposed construction violate any zoning iow, ordinance or regulahon~ .................................................... 13 Name of Owner of premises-- --.~....~.?..~.~.~.',.'.!....~.. ..~.t~.gt.M-~.~.~.~.., .~b~.,.~, . Phone No. ...Address' i .............. Name of Architect ................................................ Address ......................................... Phone No ............. Name of Contractor ................................................... Address ......................................... Phone No ................ PlOt DIAGRAM Locate clearly and distinctly all buddings, whether existing or proposed, and red,cate all set-back dimensions fron property lines. Gwe street and block number or descriphon according to deed, and show street homes and red,cat. whether interior or corner lot. being duly sworn, deposes and says that he ~s the opphcan STATE OF NEW,,Y'~,R~t , /~ t~. ' .... COUNTY OF ..~/~.: ........... ,f ~ f~ above named He is the ......................... ~~ .... ..~....~). ........................................................ (Contractor, agent, corporate officer, etc.) of sa~d owner or owners, and is duly authorized to perform cfi' have performed the sa~d work and to make and this apphcatlon; that all statements contained In th~s apphcatmon are true to the best of his knowledge and belief, an. that the work will be performed in the manner set forth ~n the application filed therewith .S..w..~:.~..t..o...b.~.f.o..~.e dmoeytho;S,. ............. .,~.~ ........... ,19 ~ ~ I , -~ , .... ............................. Coun~~"~J (Signature of applicant) MILDRED CHAPMAN NOTARY PUBLIC, Stt~te al New York No 52-0618100 Suffolk County CommJss~on FJ(P~res March 30, 19_,~_/__