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Home My WebLink About4400-z FORM NO, ~ TOWN OF SOUT~OLD 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? z Permission is hereby gronted to: .......... · a~.t;L%uek ................................................ at premises located at ................. let...~.~....CaFt,..~Add,..e~t~te~ ............................................... .... : .......................... I~j~aJ ..aea4 ..&..;IGC, et.. 3,aue ....................................................................... pursuan* to application dated ........................ jt~ ..........~ ........... , 19~.., and approved by the Building Inspector. ,Fee $.~.~.~. ............. Building Inspector TOWN OF ~OUTHOLD BUILDING DEPARTMENT _ . ,,--:/ ~ --' .~. SOUTHOLD, N.Y. l~.~./.~::2f,~, ,j~...~:.,~'~,~,c~ "~ ...... A~li~i~ A~ed: ....................................... , 19 ........ Pe~it No....~..~ ................. ~ ~ ~ D'Mppr~ o/c ..................................................................... . ................... ...................... ~ 3o ~,..~. .... IN~RU~I~S o. This application must be complexly fill~ in by ~writer or in ink and s~mi~ in ~plicote to the Buildi~ In,acer. . b. Plot plan showing I~otion of lot ond of buildings ~ p~mi~, ~loti~shio to odioinin~ oremi~s or nublic st~ts oreos, and giving o ~oiled ~ripti~ of I~t of p~ mu~ ~ d~ on t~diogr~m whi~ is c. The work covered by this oppli~ion m~ ~ ~ c~nc~ ~fore i~nce of Building Pe~it. d. Upon oppr~ol of this opplicoti~, ~ Buildi~ Ins~ctor will i~e o Building Permit to the ~plicont. Such ~rmit shall ~ kept on the premi~ available for i~ti~ th~ugh~ ~e p~ of the ~. e. No building s~ll ~ ~cupi~ or u~ in whole or in po~ for any pu~e whatever until o Ce~ificote of ~c~oncy sholl have been granted by the Building In--tar. APPLICATION IS HEREBY NLADE to the Building Department for the issuance of a Bud ng Permit pursuant to the Building Zone Ordinance of the Town of Southold~ Suffolk County, New York, and other applicab · Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for remova or demo it on, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. Stanley 8epko (Signature of applicant, or name, if a corporation) Nattituck N.Y. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Contractor Name of owner of premises .~L~,J.(:I,I~.....~DJ.R~ .............................................................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Capt Kidd . 1. Location of land on which prolx~ work will be done. Map No.: ........................................ ~ot No.: ~/- .~ o ........................ Street and Number ............. *~/~....~,:L~__~__m__.,~:l~(~ ........... ~.~,~lle,,~ .................................................... ~' / - /.~.~_~ ::z"~' ~ ,~'.~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...~eZ.~L~:~g. ............................................................................................................ b. Intended use and occupancy same with an addition 3. Nature of work (check which applicable): New Building .................. Addition ....~.. ............ Alteration ....... ~ ...... Repair .................. Removal .................. ' Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ....1.e.0.00. ............................................Fee ..~'. ..................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... .o...~..e. ............... 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 ........... ~1..0. .................... Rear ............1.0 ............ Depth ...~,~.+.. ............. Height .................... Number of Stories ..................................................................................................................... 9. Size of lot: Front ............................ Pear .................................. Depth ................................ 10. Date of Purchase ........................................................ Nome of Former C~vner ........................................................ !1. Zone or use district in which premises are situated ...~..~'..I.t....~'..~....~..~.. .............................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation.;) .......... 13.O ............................................. 13. Name of Owner of premises ][~l,~.(;],~3~.f~...~IS.t. ...... Address ....Y~e..t,t;:Lt;zzP. J[ .................. Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ~..~....~..~.]p~l. ................................ Address ..]~[8,~.1:;~1;11(3]r. ...................... Phone No ..................... PLOT DIAGEAM Locote clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions from property lines. Give street and block number or description according to deed, and show .street names and indicate whether irlterior or corner lot. __.,~,~ ' '~ STATE OF N~ Y~K. ~ c ¢ COUN OF ............. ......................... ~.~..~e~ ...................................... '..being duly sworn, d~oses end says t~ he is the opplicont (Name of individual signing ~lication) above n~med. He is the ............... ~O~[~C.[O~. ................................................................................................................. (Contractor, agent, co~orate officer, ~c.) of said owner or owners, and is duly authorized to perform or have perfo~ed the said work and to ~ke and file this application; that all statements contained in this application are tree to the best of his knowledge and ~lief; and that the work will be performed in the manner ~t fo~h in the opplicati~fil~ ~erewith. 'Swam ~o ~fore~dayme thiSof ~;.....~ 19..6~. .................... ........... ............. , ............................ .o ' ~ ~ ~mmis~i~'-~ March ~ lg~