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Home My WebLink About4337-z FO~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 4337 Z Permission is hereby gronted to: at premises located at 9$edriek £.0,~;, W..~J... ~a:ta ~d ........................................... O~e~t ......... =..y. ................................................................................... pursuon¢ to applicotion doted .................................. 'T.....I~t...e. ........ ~....., 19...~., end approved by the Building Inspector. Building Inspector J TOWN CLERK'S OFFIGE ~~ ~ ~n~' ~D, ~. Y. /~ ~' /~ ~,~, ............. ,, .......... . ,~ ".... ~.~,, ~0 .~ ~ ~? tfx.~ ~ ~ ~_~ ................................. ~ ~-~.~. ~ . , ~ .............................. ~ ............ ~.~~,-~- ~,~ ~ ~, ...... I V ~ ~ ~ I '~../ ~ ~' ~ 'T~ZZ / ~ ....... ~ ........ ~ ......... ~ ................ ~.~.~....~.~ ~ ~ a. ~is applic~t~on~ust be ~ompl~ely fill~ in by ~ewriter or in ~nk and submi~ in ~plicate to ~e Building Ins~ctor, b. PI~ ~l~n sh~in~ I~tio~ o~ lot and of bu]Mings on premiss, relationship to adjoining p~mi~ or public st~ or ar~s, aha g~wng a ~a~ed de~npt~on of I~y~t ot pro~ m~st ~ d~ on the diagram ~ich is ~ of ~ ~llcati~, c. ~e wo~ c~ere~ by tNi~ application m~y not be commenced before i~u~ce of Building Pe~it. d. U~ appmwl of this ~pplication, the Building Ins~ctor will i~ue a Building Pe~it to the ~icant. S~h ~rmlt shall b~ k~t ~ the premi~e~ ~v~il~ble for inspection tN~ug~out the pr~re~ of t~ work, e. No building s~ll ~ occupied or used in whole or in pa~ for any purple whatever ~niil a C~ific~t of ~c~ncy sNoll have be~n ,granted by the Building Insp~tor. APPLICATION IS H~R£BY/v~D£ to the Building Department for the issuance of a Building Permit pu~uant to the Building Zone O~inance of the Town of Southold, Suffolk C~n~, N~ York, and other applicable ~, q~i~ces or Regulations, for the construction of buildings, additions or alterations, or for rem~al or demolition, as ~mm.~rib~ ~e applicant ~ ~o comply with all applicable laws, ordinance, building c~e, housing c~e, ~d regulations. ~ ~ ~, ~,/ n~ ~ru~- (Sign~ure of applicant, or na~, if a co~l~) ~~-~ .............................. ~,."'"'~"~'~ ~=.t'"-""-~ .......................... State whether a~essee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premise~..~....~..e~....~.. ....... .~.~..~.; .............................................................. 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. Map No.: ........................................ Lot No.: ? ....................... Street and Number ................................................................................... .(~..~ ..................................... 2. State exi~i.ng u~ and ~cupancy of premiss and intended use and ~cu~n~ of prop~ con~mcti~: a. ~isting ~ and ~cupa~y ...,~ ........................................................................................................................ b. I~ use a~ ~cupancy ~ 3. Nature of work (check which applicable): New Building .................. Addition ...... ..~......... Alteration Repoir .................. Remo¥ol .................. Demolition .................. Other Work (D~cribe) ........................................ ~,' 4. ~timoted Cost ............................................................ Fee .......................................................................................... (to be paid on filing this application) ~ 5. If dwelling, number of dwelling units ...... ?. .................... Number of dwelling units on each floor ....L ................... ~... If garage, number of cars ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specie/ nature and extent of each type of use ............................ 7. Dimensions of e/xisting structures, if any: Front ....... ..~:....~.. ............. Rear ....~.....<~.. ................... Depth ..,~..~. ........... Height ....~...~../. ........... Number of Stories .../. ...................................................... i ..................................................... Dimensions of same structure with alterations or additions: Front....................................~'? Rear .~..?. ..................... Depth ..~......~'.. ..................... Height ............................ Number of Stories ....... ..-~.-. .................... t 8. Dimensions of entire new construction: Front ..~..~ ...................... Rear ....~....-~...~ ............. Depth'...g..~.. ............. Height ...~../. ............. Number of Stories ...J. ....................................................... ~; ...................................................... 9. Size of lot.' Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises ore situated .................................................................................................... "~;'7-__ 12. Does proposed construction vi.elate any zoning law, ordinance or regulation? ..,'.~...~....~..~,. ....................................... Name of Owner of premises .a.~ Address ...~...~ Phone No w~.~. 1' ~' Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ~.~..~.~ ......... Address ..~..~."....i..i.... Phone No."~..iJ~..'..~...~..~.O PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimension~ 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 NEA~/%Y~,///' JSS F r~'~,~'~-, v, ~'-~/ · .................... ~~ being duly sworn, deposes and says that he is the applicant oboYe 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 are true to the best of his knowledge and belief; and that the work will be performed jRthe manner set forth in the applicationr filed therewith. Sworn to befgre me this {, J C~ ~ ' ~ ........................ day of .......... ~ ............... , 19...~.... ~_ ~J~'~ r.x~',//-'"~'"~ - ~ . , .o 5 ..... ......... ...................................... Notary Public,~~.l..,x/~2A~_,~.(,~E~,~.,.~.~CountY 6~~ (Signature of applicant) RRY P -- ~I~TARY PUBLIC, State or'New York ~o, 52-8125850, Suffolk Cou,,~ ~,~ Expires March 30, zg,.~