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Home My WebLink About4310-z FORM NO. 2 TOWN OF $0UTSOL~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 4310 Z Permission is hereby gronted to: ............ ~..e..r.....a....~.l.~.e..s...s.~ .... ~ .~.....~.~je~o= ~>et~t ............... Jio.u.~l~oi,it ............................................. to ......... lallli..add, l*,Io~ ..&..ltalce..elie~,&t lea& ..eJ.. an..el~$11~..~tl.~ ...... at premises located at ................... P.l'.t,I/&J~...iJo&iJ ............................................................................ ............................................... li~.-C~l~.~-e~k ......... l~vYv ................................................................... 19...~.[}., and approved by the pursua:n¢ to application dated ................................... }~.~.~......~.,~. ....... , Building Inspector. Fee $.....,~J~ ......... "~uilding J~spectbr (Building Inspptor) ~- APPLICATION FOR BUILDING PERMIT ~7 '~)-- ~- ~te ....... .~. ........... .~./.....~.~ ........... ,1~.~.7.. ..... INSTRUCTIONS Inspector.a' This application must be completely filled, in by typewriter or in ink and submitted in duplicate to the Building b. PI.at .pi.an sho. win.g, location, of. lot and of buildings on premises, relationship to adjoin ng premises or public streets or areas, ana g~wng a detaded doscr~phon of layout of property must be drawn on the diagram which is port of thie 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 ~.~geulati.ons, for the construct!on of buildings, additions or alterations, or for removal or demo t on, as heroin described. e applicant agrees to comply with all applicable laws, ordinances, building code, housing code, a~d regulations. ...................... ~...~..~.....~.z....~.:...z.~.l....~ ................... (Signature of applicant, or name, if a corporation) (Address of app"~l~c~nt) ' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bui der. .................. .~...~..~..~.~,....: ................................................................................................................... ,. ...................... Nomeofownerofpremses/~.~..ji~..~../j~..~..~..~.~..~.: ,~.X?. , ~J~'/,A,~-~ ~/ ~V~-4~/~ ' 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. J~A~ No..' ............................. Lot No.: ........................ Street and Number ....................... .~./. ................................................................... ~..:..'.~4,~ 2. State existing use and occuPancy of premises and intended use and occuPancy of praposed construction: a. Existing use and occuPancy ........ ~ ..................~ ........................................................................... b. Intended use and $~/~ ~-~ ocCUPancy ......................................... ~ ....................................................................................... ¸5, 3. Nature of work (check which applicable): New Building .................. Addition ....~ ...... Alteration * Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........... i.,~ ...................... 4. EStimated Cost .~...~-~2 ~--~".. Fee (to be paid on filing this application) 5. If dwelling, number of dwelling units .......... ./. ............... 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 ...... ~.*..~'....~. ........... Pear .....~...~....~. ................ Depth . .~..~.....~ .......... Height ~' 5~ Number of Stories ~' ........................................................................... Dimensions of same structure with alterations or additions: Front ....... ~....~. ..................... Rear ..~...~.. ................... ~,s-~ z Depth ......~...'7. .................... Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number .of/~ries ..................................................................................................................... 9. Size of lot: Front/~t~...~.~1~.. ~P, ear ................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ...Z~.~..'s....z..~...~...~.;..7~...~'...~/.....~.. ........................................................... Does proposed construction violate any zoning law, ordinance o~r~egulatio~;~ .....~(...O. .................. 13. Name of Owner of premises/~/.~'~i~J~.~..~...-Address ~/~~t~..~..~.:..i Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor l~..~¢~.~[l~..~...~..--./....~.(~.~'./..~'.~..~/..Address ...~.P....~..7:'...~...9..~....6~........./~../~. Phone No..~.~..~.Z~/ PLOT DIAGRAM Locate clearly and distinctly all 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 i~terior or corner lot. .............. ¢ , ...................... / ?U"T ,el STATE OF NEWt~/'OR~ e/, ......... ( COUNTY OF .~ ~S;S. , · ...~..t,~./,~/~ ..~/(.~/.(..~..~..~.~....~.~.. ........ be ng duly sworn, deposes and says thor he i--~-t-~ ~ (Name of individual signing application) ~// 2) e'-,,P... . ......... ............. above named. He is the . .~...' ................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make a~d file this application; that all statements contoined in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. SwOrnc~ ..O~....t° before meday thiSof ~Y) O.z/ 19 ~.~.. · ~ Notary Public,~~Z'-~.~ ..... C~:~'~''' ''~':''' '~'''~(signature of applicant) .................