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Home My WebLink About3597-z FOR~ NO. ~ TOWH OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, ~. Y. N? BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL .FULL COMPLETION OF THE WORK AUTHORIZED) 3597 Z D~e .................. :.....~t~.....~...~ ..... ,~...6~' Permission is hereby granted to: ~t~U~k"bu~d~u~ '~o~-','~e"~"- ........... ~at~tu~ ............................................... at premises located at .Jteye~,--;F~l-.&-.G~cV.Ave .................................. -..: .................................... pursuan¢ to application dated .......................... : ....... ,At~t~....~)., 191,~.., and' approved ~y the Building Inspector. '~ Fee $,.~.Oe.GO. ......... FORM NO. 1 TOWN O~ SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ...: ............ ~.....-,~t .............. Approved ..................... : .................. , 19 ........ Permit No..;>....,~...Z...r.*....,~..,. APPLICATION FOR BUILDING PERMIT Date ............................ >.~..~.';;::0~......:~:f:?....., 19.: .......... 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 part 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 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. APPLICATION IS HEREBY MADE to the Building Department for the issuance 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 removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code and regulations. "~ (Signature of applicant, or name, ff a corpora'~'on) .... ........ (Address of applicant) ~/ State whether applicant is owner, lessee, agent, architect, engineer,, general contractor, electrician, plumber or builder. ......................... ........ ..... ..................................... If applicant is~r'coJ~orate, sjgn~;~'u, re_,~f.~uthorized officer. (Name ar~it~'e of c6rporate officer) 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No.: ........................ Street and Number ............................................................................. ~....i~./~ ....... /~.~J ..... Municipality ~1~/~ ~ I ~¢' C 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .................................................................................. ~ ................................................ b. Intended use and occupancy .............. .(~.....~...~.- ............ ~....~/.../..I ............. .~.....~ ................ ..~...~. .......................... 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration ReF air .................. Removal .................. Demolition .................. Other Work (Describe) 4. Esti'noted Cost .......... __,~..y ...... .~....~..~....~...:......¢.....~.>. ...... Fee i (to be paid on filing this application) 5. I¢ dwelling, number of dwelling units ....... ~.../~..~.~. ....... Number of dwelling units on each floor ..... ¢~....~..../".-.~... If g,arage, number of cars ................. .~.../~. tC 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use Dimensions of existing structures, if any: Front .........~ ................. Rear ........... :. ...... : ............ Depth 7. Heibht ........ :..-Tz..; ......... Number of Stories ............ ~ ~ .-. Z ~;7 ................... Dim. ensions'l of sQme structure with a.lterations or additions: Front .................... ~;; ....... 7. ..... Rear '" De, th ~-'--- Height ........... ~. ............... Number of Stories ' 8. DiMensions of entire new construction: Front ........ ~..~ .................... Rear ...... ~..~...~ .......... Depth Height Number of Stories ....................... .~..7¥¢..~.. 9. 'Sizq of lot: Front:~,~.~.'....;~.'.,~..'...~...;;' Rear ....... /...~...~. ................. Depth ....... 10. Datp'l of Purchase ........................................................ Name of Fo/'mer Owner .............. .~....~....~.. ..................... 1 1. Zor~e or use district in which premises are situated .................. ~..~ ............ 12. Does/ proposed construction violate any'zoning Iow, ordinance or regulation? 13. No,ne of Owner of premises ........................................ Address ............................................ Phone No. Name o1: Architect ................................................... ...Address ............................................ Phone No. Na~e of Contractor .~l~.T."~.l...T..~...C...~.....L.~.?..l.~.~l.~..~ddress ....~...~.'~...L..~...~...I~.~ .............. Phone No. PLOT DIAGRAM I_acat'~ clearly and distinctly all buildings, whether existing or proposed, and indicate oil set-back dimensions property lines. Give street and block number or description according to deed, and show street names and whether in,terior or corner lot. STATE OI S.S. COUNTY IOF !(Name of ~' individual signin abow; nor~ed. He is the of said o~ this appJi, that the Sworn to efore me this ........ ............... , #el~fy Publl~, 8tMe of New ~ll No. $0-5712500 Qualified In Suffolk County, ,~ dul~/ sworn, deposes and says that he is the oppli( (Contractor, agent, corporate officer, etc.) ,her or owners, and.is duly authorized to perform or have performed the said work and to make and :atlon; that all statements contained in this application.are true to the best of his know!~dge and belief; ork will be performed in the manner set fbrth in the application filed ~licant)