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Home My WebLink About4351-z FOI~M NO. ~ TOWN OF SOUTHOLD BUILDING DEFARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne. 4351 Z Permission is hereby granted to: at premises located at .................... ~l~.9~l~..~...~...~.lJ.~..~.~l~ ................................................... .................................. I~mt~.~ ....... I,X, ............................................................. pursuar~t to application dated ...................... ; ........... ~ ....... .~...., 19..~.., and approved by the Building Inspector. Building Inspector J ,~/~-~ (Building Inspector) ~ '" APPLICATION FOR BUILDING PERMIT INSTRUCTIONS 'cl. ~ This application must be completely filled in by t~pewriter or in ink and submitted in duplicate to the Buildin~ Inspector.../~. b. 'Plot plan showing location of lot and of buildings o~ premises, relafionsh p to adjo nJng premise~ or public streets or areas, and giving a detailed description of layout of praperty must be drawn on the diagram which is part 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. .A..P. PLI?TIO~N,!S HEREB. Y.MADE to t.h_e Building Department for th~: issuance of a Building Permit pursuant to the Buna~ng :one ura~nance at me Town of :Southold, Suffolk County, New York, and other applicabl® Law~, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, b~ing,~, housing cod~, and regulations. ....... · : (S,gnature of applicant, or name, if a (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .............................. ;. ...................... ~lQ,e.l~ ....... ' ............................................. ~ ...................................................................... Nome of owner of premises ..,6~:'.i;.~.)&lC..~...~:~,g~.~..~U. aA&..~,~)g.l~.~.' If applicant is a corporate, signature of duly authorized officer. (Name and title o~ ~rporate officer) 1~ Location of land on which proposed work will be done..Mo.p No.: ...... ..~...........~. ................ Lot No.: ..,../~../~ . .. Street and Number ...S,/l~-..~.OZ:l~e~..~e~.1:D~.j~,l~le...l~,~...~.t~....D.~a .~..o...~..t..~...o.~..~.~ ...1~... ....................... 2. State existing use and occupancy of premises ~ intended use and 'occupancy crf proposed construction: a. Existing use and occupancy .~ ....... a'l'l~°~e~....c.~.~;~j~a~,e,..!:':., ..' .... ~, ....... b. Intended use and occuoancv '.,. 0LlJql~e~'r' Ootta~e 3.Nature of w~rk (check which applicable): New Building .................. Addition ..... ~ ........ Alteration .................. Repair .................. P~pmoval .................. Demotitior .......... .~ ..... Other Work (Describe) ........................................ 4. Estimated Cost ....... 'f.../~..a ......................... ~ee ......................................................................................... (to be paid on filing this application) ~ / ...... Number of dwelling .units on each floor ' 5. If dwelling, number o~'dGeliing units ...................... ~ If garage, number of cars ............................................................................................................................................. 6. if business, commercial or mixed occupancy, s~.f~/ nature and extent o,~ ~ach type of use ........ ...'~, ............... 7. Dimensions of existing structures, if any: Front ...... :..~. .................. Rear .......'~...~....... ............... Depth ~..~......~..[ ........ Height ........................ Number of Stories ........ ~.~ ............................... :~,t ...................................... ~:~;--~?.~ ......... Dimensions of some structure w~th alterations or add,hans: Front .................................... Rear ........ ; .................. th ~ ~ *. . Heght Number of Stories & Dimensions of entire new coostruction: Front ................................... Rear ............................ Depth ........................ ! Height .................... N urn~;~,~f Stories .......................................... ~; ......................................................................... 9. Size of I'ot: Front ' / ~ Rear IO'V~ Depth 10. Date of Purchase ........................................................ Nome of Former Owner ........................................................ ~-1. Zone or use district in which premises ore situated ..................................................................................................... ]2; Does proposed construction violate any zoning law, ordinance or regulation? ...... .blO ................................................. . o . 13,. Name of Owner of premises ........................................ Addres~...~ ........ ~.q.~. ............. Phone No ..................... Name of' Architect ...................................................... Address/.~.,~'--4~'-~f.~.~....~/.:y.~./~'..~...~..~... Phone No. Nome of Contractor .........................................Address ............................................ ~ Iqo. PLOT DIAGRAM Locate clearly and distinctly ali buildings, whet.her exis. ting or pr,.~.ed, ,an~, indi.cat, e all .set .d~ock dimens! .o.ns,.fro.m property lines. Give street and block number or aescript~on accoramg to aeea, ana snow ~rem names aha mmcam I' ': ......... - I~/~ IS~ ~.~ ~/ F_.Xl~-~-~l.l& .~ 19rJTSIDE ~l(,, LOcuSt poeT' Ex'~rt~'/, oz~u~, STATE O1: NIIW YORK*;. ~ c c COUNTY OF J._~ .6....~..'..q~... ........... ~'~' A~H.~...~......E.~...~...~.....~.~...~ .................... .~. ...................... being duly swam, deposes and says that he is the applicant (Name of individuot signing application) above named. He is the ............................................................................................................................. , .......................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove performed the said work and tO make and file this application; thdt all sfatements ~ontoined in this application Ore true' tO the best of his knowledge and belief; and that the work will be performed in the i~ner set forth in the application filed therewith. Swam to before ree this ~ ................... ....... · ....... ....... ...................... kl~,~ Public ~ ~~,~uHuR.~,~ v^,k (Signature of applicant~' CEINT!~.AL D~ivr-