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Home My WebLink About4319-z FOEM NO. ~ TOWN OF SOUTSOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PEP. MIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°. 4319 Z o~, ...................... ~.,7J/~.n ......... Permission is hereby granted to: ................................................................. pursucu~t to application dated ............... ~ ......... ~ ........................ , .,, ~/~, pp Y Building Inspector. Fee $-- ./.-~.. Building Inspector AppliCation No ............. ~..~.... ....... AI~LICATION FOR BUILDING PERMrl 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 pmm.lses( relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of prof~ed~ must be ~;~wn on the diagram which is port 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 Inspactor will issue o Building Permit to the applicant. Such permit shall be kept on the premises available for impection 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 Occapancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit ~suant 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, additio~s or altllfl~:)ns, or for remov~l'l-¥ demolition, as herein described. The applicant agrees to comply with all applicable lows, ordi~lo.nc¥, I:~lilding code,~hojbsing code, arid regulations. ......... · ........ ............................... ............................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. CFP US Name of owner of premises .................................................................................................................................................... If applicant is a corporate, signature of ~UlY authorized officer. (Name and title of corporate officer) I. Location of lan' on--I - '-- -- ill---- AAa a wncnpraposeowomw ~eaone.~ ,/~ ~~~pm .: ........................................ Lmmo.:~. , ................. Street and Number ........................ -- ..~..~.../~?.~....~.... ~~~ .... . Municipality 2. State existing use and occupancy of premises and intended use and oc,cupancy of prc~c~ construction: 3. Nature of work (check which applicable): New Building ;~.......:..; ..... Addition .................. Alteration ............... Repair .................. Removal .................. Demoli~ion......~.;....;..... Other Woj:k (Describe) ....................................... · -1~. ~o0 : ' ~ / ~ ~ ' . 4. Est, mated Cost ........... l.: ................................. ~. ........... Eee. ...... ~.....X.. ....................................................................... (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 ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ~ ........................... Number of Stories ................. .~.~. ........ 8. Dimensions of,entire new'construction: Front ...........~..~ .............. Rear ........ ~L~. ......... Depth ........ ~..~,-... Height ...l~.. .........Number of Stories ...........~ ......................................................................................... 9. Size of lot: Front ........ ~...~.. .......... Rear ................. ~.~ ......... Depth ......... /..~..../. ....... 10. Date of Purchase ........................................................ Nome of Former Owner ........................................................ ! 1. Zone or use district in which premises are sitUated ..................................................................................................... 12. Does proposed construction violate any zoning Iow, ordinance or regulation? ..................... : ................................... 13. Name of Owner of premise~a/~e~,...~..Addr~-~...../..7/.~-..~ ~ Name of Architect ............................... ~..; .................. Address .......................... /~' ............... Phone No ..................... Name of ....... No ..................... PLOT DIAGPJ~M ~ ~,~ O/- ) 5'~ - .~.~ I ! Locate clearly and distinctly all buildings, whether existing or prapased, 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 comer lat. STATE OF NEW YORK, COUNTY OF ................................ ,~ "'"" ................ ./~/l~',~,/~...~:..k~........, ......... C.~..~"'/~./'/'"~'.....ii .......... being dUly SW°m, deposes and (Name of individual signing application) says that he is the applicant 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 and file this application; that all statements contained in this appliCation~ce true to the b~[ of his knowledge and belief; and that the work will be performed in the manner sat forth in the apl~licc~on filed ther~t~. Swam to before me this~ ............ .............. ....... ....... ., ..... ...... , .. ...................... r~otary ~um c, · ....................... ,,~.b'..t...,~..-~,'-.~: ...... . n~T~,'r PUBLIC. St~t~ ';~'~e~,re ~t~app,cant~ ,t~ I) ' ,i L~). I?-- lC-." O. Co ~C C 5 TV~ ~ ..,, ~5;5., :"' ¢O~L ¢ W'A~TE - ,OIFIN~ OI,4G~.I~M NO SCALD ~c C.A L E ///~ I LO' fl O Ti: x' fACToe./ g ~_~-~ IV CA 5T L~ /J 5"2 ~ o"