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Home My WebLink About3551-z FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT fl-HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 3551 Z Permission is hereby granted to: ................. ~~i....i!....~... ........................... to ~.....~.....~$~.~....~..~.....~.....~..~$!~..~...~....~.~s..~.~ ......... at premises located at ....~....~...~. ......... ...~.~....~......~.....~......~.....~ltl~t..l!l. ill ......................................... ................................. II~.~...~ ........... ...~t~S.t~ ................................................................... pursuan¢ to application dated .............................. ~'.1~ ......... .~1~1....., 19..~.., and approved by the Building Inspector. BUILDING DEPARTMENT TOWN CLERK'S OFFICE Approved ........................................ , 19...:.'... Permit No ....~........~'.,...~../ Z-- Disepproved a/c ...~~- (Building Inspector) Application No. ~"~"~'/ APPLIC:ATION FOR BUILDING PERMIT 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 premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of prOperty must be drawn 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 Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for ir~pection throughout the progress of the work. e. Nil.building sholl be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy sholl have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the ~Build!r~.. Zone. 0~. inance of t..he Town .o.f .Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Kegulat~ons, for the construction o.f buddings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply w~th all applicable laws, ordinances, building code <)nd regulations.. .... ............................................ (S'g atu · of c~,plicant, of nam, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer. (Nome and title of corporate officer) ,~ ,.~.Z ~....~...,~ ~ ~,~, 1. L~ationof andon~ ' m ~d~rkw done N *~ P P ~ ~ · ~P ~9.~'.~-- .~ ........... v ........ Lot No.: ........................ St~ a~ mumDer ................. ~.. ~ ........................... ,~, .......................................................... Municl~li~ 2. State existing u~ a~ ~cu~ncy )~mmi~s and intended use and ~cu~ncy of p~ construction: ......... ......... .................................... b. Intended use and ~cu~ncy ................................................................................................................................. 3. Nature of work (check which applicable): New Building .................. Addition ....~. Alteration .............. :... Repair Removal Demolition .................. Other Work (Describe) 4. Estimated Cost ........................................................./~5-0'~ . Fee .~.... ................................................................................... (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 ........ Z'... ............... Depth/.~...'....~. ............ Height .................... Number of Stories 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase .................................................... ..;.~ar~eof,~rmer Owner ........................................................ 1 I. Zone or use district in which premises ore situated ~..~...~...-~....~;.. .................................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation.> ....... ..~.....u. ............................................ 13. Name of Owner of premises ..~.(~...~..~....~Lr-~.~...~ ......... Address ..,q..~...C...f.../~.:l....~...~.. ............ Phone No Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ......... ~.~..~ ..................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description occordJng to deed, and show street names and indicate whether i.nterior or corner lot. STATE OF NEW~Jf,,.~, '[ce COUNTY OF ..._.~~.....~ ' ....................... ~...~ .................................... being duly sworn, deposes and says that he is the applicant (Nol~e of individual sJl~i_n~ application) _ . above named. He ~s 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 in the manner set forth in the application filed therewith. Swam to before me this ~ ~ ................... ............. ............. ..Z ...... ..... ................. .__~/~ MILDRED CHAPMAN t ~/j /~IO]~Y PUBLIC, State of New Y~I~ No. 52-0618100 Suffolk Ooun~., (h~11mission Expires Me~'ch 30,