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Home My WebLink About4380-zTOWN OF SOUTHOLD BUiLDiNG D£PARTM£NT 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? 4380 Z O~e ............ .~ ................ ~. ....... .~.k...., 19....6.?. Permission is hereby granted to: Chal'les Kadushin .................. Fl~m~...I~l~ .......... : ................. .......................... ............. ................ Build an addition & ake alteration~ on existing dwe~!ing at premises located at .................. l~..v.t..Boad,...W:Lld~nes~.,~.ola~. ........................................... ........................................................ E~he~.s...Isla~f~ ......... N~I, ................................................... pursuan¢ to application dated ............................ ~1'~Ll~r ........ ~Li'r......i...., 10..~9.,, and approved by the Building Inspector. Fee $ ~.~.{~. .............. Building I'nspector FORM NO, 1 TOWN OF $OUTHOhD BUILDING DEpARTMENTt. TOWN CLERK'S OFFIGE SOUTHOLD, ti. Y. Application No ............................. INSTRUCTIONS a. This application must be completely filled in by typewriter or in?ink and stZ~)mitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, re~!ationship t0.adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drcwn on the diagram which is part of this location. 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. Jsfue o Building Permit to the applicant. Such permit shall 'be kept on the premises available for inspection throughou( the progress of the work. e. No building shall be occupied or used in whole or in part for an,;, p~rpose whatever until a Certificate of Occupancy shall hove been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for th~ issuanoe 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 Regulations, for the construction of buildings, additions or alterations, or[for Femoral or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinan/c~ andi regulations. (signatOre of applicant, or name, if a corporation) .:..7,.,. ...................... (Address or appdcant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises....~.~"~"~....~4~...~..~./.~/. ........... ; ............................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. I~ocation of [and on which proposed work will be done. Map No:' ..q, ................. : ...................... Lot No: .................... Street and Number ~I..~.[ ~,~t,~..~......~..g,~....~..i.,.~...~.-.~..~..~..~).~.~...'. .................................. 2. State exist ng use and occupancy of pr, em~ses and intended use ~d-'ecct~pdlS~;;y of proposed construction: b. Intended use and occupancy...~..~'.'~...~.~...i ....... ;i: ...... ................................................. 3. Nature of work (check which applicable): New Building .................... Addition ..... ~ ........ Alteration ..~.,. ............... Regqir .................... ~t~r~o~ ...... D~m°litJ'°]P""-":":'i~,'rl~ ...... Oth_e=EWork (Desc, ribe).~..¢~ .~.....~J~,~ll~ 4. :u ,.. ..... ~'...n~.,~'~ .............................................................................. .~' ............................................. "~t u~ ~ (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 ...~.../'.. ............. I Height .......... ~'..~ ............ Number of Stories ..... ...................................................................................................... Dimensions of same structure with alterations or additions: Front ......... ~...: ............. Rear .,~.~. ................... ! Depth ........... ~ ........... Height ........ I...i~.... ............. Number of Stories ...~. .......................... 8. Dimensions of entire new construction: Front ............................Rear ............................ Depth ............................ Height ............................ Number of Stories ............................ 9. Size of lot: Front ...... ~.lS...I.' ......... Rear ...... ~1',~.~ ............. Depth ....~....~....~. ........ : ..... 10. Date of Purchase ...~,~..~.~,,.......~.~. ...................... Name of Former Owner . .P....~...~!..~.~..~......~..~./.~. ................ 11. Zone or use district in which premises are situated....~...~.'.~.(~...~..~/.~f...~.. ............................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? ~...~. ........................................... 13. Name of Owner of premises~.~/.~....l..~'.~,~..~.~.//ff...~Address .~.&,c//~.~...~.~..~.. ....... Phone NO. '~..'-'~..~..~ Name of Architect ........................................................ Address ............................................ Phone NO ..................... Name of Contractor .................................................... Address ............................................ Phone NO ..................... PLOT DIAGRAM Locate clearly and distinctly ali buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW ~OR~ ~ ~ ) S S I~ILI~'N G' W~LL Qua ed'i 2~9509185 ~', Term ~Xpite n. oullolk C~-n- ~'P (Natural individual signing application) above named. He is the....~.,.~'~-~ .............................................................................................................................. (Contractor, agent, corporate officer, etc.} of sahJ 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 beHef~ and that the work will be performed in the manner set forth in the applicati~fi}~ therewJt~/ Sworn to before me this Zg.~.~ ..... day~f .... .J..~.[.~ ....................... 19~ ...... (Signature of a~plicant)