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Home My WebLink About5074-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD; iq. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES rd.NTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 507~ Z Permission is hereby ~ranted to: ...... ~....,~,:..~. ...... ~.,s...~.~.c,.Z~,.~..~t. .... to Building Inspector. ~ee $ ............... .................................... ~:~..~E.~.....~.~.~..s.. .......... .~.r.z~ ............. ,. ................. ". ....... ........................... : ......................................................................... ~ ........... ~ ......... ~ ....... ;..: .................. appr~ by the Bui?~,~.ng: insp?tor , S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located (Give deed 'location) ?U have been inspected by this department and found to be satisfactpry. 5 Chief of General ~gineerin~ Se~icee SEP 2 8 1971 Z c)/ .J-O-? ..LO"-/ NO, I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. (Building Inspector) Application No.....~....~...?.~... ...... INSTRUCTIONS o. This application must be completely filled in by typewriter or in ink und submitted in duplicate to the Bulldh Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets, areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appllcatio c. The work covered by this application may not be commenced bafore issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such pern- 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 Occupan[ shall have been granted by the Building Inspector. APPLICATION IS HEREBY MA, DE to the Building Department for the issuance of a Building Permit pursuant to ti Building Zone Ordinance o! the Town of Southold, Suffolk County, New York, and other applJcoble Lows~ Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe The applicant agrees to comply with all applicable laws, ordinances, b. uilding code, housing code, and regulatL0ns. - ~aaress o? applicanT) / State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build~ ................... .~.. .~ /.v:'. ..7... .~. .~. . . .c ........ (......',,,. ................................................................................................................ Name of owner of premises ............. ~..?,,.....'~.......-~... ........ 4~,47.,A~...,~...T...Z'~..~..,.~...~./.~.,/Zh4. ....... ~,~.,~....-/-~,., .................................. If applicant is a corporate, signature of duly authorized officer. (Name and title 'of corporate officer) 1. Location of land on which proposed work will be done Mop No.: .......... ._~'..~/.~/..~ .............. Lot No.: ./..~....'~.. .......... Street and Number .................................. .~.."?F..A..A/..~.L;...t .......... ~..~_~ ................. .~..'T.-.~.,./,..'7..,.I/..~./~ ................. Municipality 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 occupan,, 6zA/./=.; ...... '-,/~ ~. ~ ~ I ~ ~ ~., ...... 3. Nature of walk (check which applicable). New BuHd~ng .................. Addltmn .................. Alterahon Repair .................. Removal .................. Demolition .................. gther Work (Describe) ...................... o 19 701'J i~ ........ 4. Eshmat~d Cost ................. ~ .......................................... Fee ../.. ...................................................................... (to be pa~d on fi:rog th~s application) 5. If dwelling, number of dwelling umts .... ~.../.~....Z.:. ........... 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 ............................. N~mber of Stories ......... .,-z-./ ............... . . -- 8. Dimensions of entire new construction: Front ............ .:~;;:.. ................. Rear .........-,/.T.. ............. Depth; ................. .&...9.. ./..:./. / 9. Size of lot: Front ........ ........... Rear .............!...~...../. ............. Depth 10. Date of Purchase ..................... (.~...Z..~.~ .................. Nome of Former Owner .... :.~.:..~ ........ ~.!.~. .................... 1 I. Zone or use district in ~hich premises are situated ~ ~ / ~'~ 12. Does proposed construct,on dol~te any zoning law, ordinance or regulahon~ ......................................................... 13 Name of Owner of ' ' ~" ' premises ........................................ Address ............................................ Phone No .................. Name of Architect .'~...~....A...N.....T..~....k.~.!...~. ........................ Address J' ~ v',-rr ~ ~/^! Phone No. ~ . . ~,ssr~ ~z~ re,s-r _.. "~'~"~'"'~x;'~"--"'"--'"" ~""'"'- Name of ~on?racTor .................................................... /~¢loress ............................................ -' Phone No ................. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ex,sting or proposed, and indicate all set-J:x3ck dimensions ftc property lines. Give street and block number or description according to deed, and show street names and indica whether interior or corner lot. STATE OF NEW,~OI~I~ ,~/~ ~ S S COUNTY OF .~/-,,t~.~ ......... $ ~ ' ............................................................................................... b~ing duly sworn, d~oses and says t~t he is the appJica (Name of individual signing applicahon) above n~med. He ,s the .................. .([~.~.~.?~.~..~..].~.~ ............................................................................................... (Contractor, agent, comorate officer, etc.) of said owner or owners, and is duly authorized to perform or have perfo~ed the said work and to ~ke and fi this applicahon; that all statements contained in th~s apphcation are true to ~e~best of his knowledge and behef; that the work wdl be performed in the manner set fo~h in the application find ~ewith.~ Swomto~fore methis , . ~ . / ; J/j/ , ~ / ................ o, .... ............................ / ~t~F~r ~t~ ..... ~ ............... ~ ............. g ..................................................... Notor/Public,~ ...................... ~ ......... ~ ................... ~ Coun~,.//~. ~ ~ (Signa~re of applicant) ~~~ ~~ NOTAR~PUBLI~,~Sta~ of New York ~~ N~ 52 8]2585d, Suffolk Cou~t~ Term Exp~r~s ~rch 30, Ai 24.*0 ;4,f0 tl~.O'1 ........... ~ ] .