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Home My WebLink About4952-z FORM NO. ~ TOWN OF sOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Yo BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISE COMPLETION OF THE WORK AUTHORIZED) UNTIL FULL N? 495~ Z Permission is hereby granted to: · · ............ ~t~;t,e~..Oe~,~l~ ................................. to . . .~. aa ~t~ea ea. e~t~.~t, mit3/ag ................... at premises located at ........... ~*"~'~"~I~ ........... : ......................................................... ......................................................... ~re:thotil~ ....... ll'i~ ................................................................... pursuant* tq application dated .......................... ~/~1~...,.~$ ......... :,,.,., 19...~, and. approved by the Building Inspector. Fee $....~,4;)j) .......... Building Inspector TOWN OF soUTHoLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. reNO. I ~ Appl,cation No ........~...~....~..~ ..... Examined ......... ~.."./..~....., 19,?,...?. ,, ,, Approved ........................................ , 19 ........ Permit No ..... Disapproved a/c ............ ~... ' (Building Inspector) I":F i APPLIGATION FOR BUILDING PERMIT Dote ........ ~4~, .~,~:.7.,/Z./- .................. ' .......... , 19..~...~......~.1 INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink'~und submitted in ck~plicate to the Buildings Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premisa~ ar public streets or~ areas, and giving a detailed description of layout of property must be drawn an the d~agram whlch Is part of thie 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 hove been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building~Department for the issuance of a Building Permit pumuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lawl, Ordinances or Regulations, for the construction of buildings, additions or 6Iterations, or for removal or demolition, os herein described. The applicant c~grees to comply with all applicable laws, ordinances, building code, housing code, and regulations. (Address of'applicant) State whether applicant is owner, lessee, agent, architect, engineer, generaJ contractor, electrician, plumber or builder~ ....... ................................................... .................................. ....................................................................... Name of owner of premises ......~...7..~.¢.~.¢~.....~..~.~.~.(:..~....~,/~"Cf~. ......................................................................... .~ If applicant is a corporate, s~gnature of duly authorized officer. ,~ (Name and title 'of corporate officer) Street and Number ,~.~..~...:.:.. ~. ............................................. . .~..o..~.~:-.,~,~.~. ................................ F/ '~ Municipality 2. State existing use a~d occupancy of premises and intended use and occupancy of proposed construction: aa Existing use and occupancy ....... /,..../~-,~..'~-,/,,~..%...,~-.~-.,~,~* .................................................................................. Intended use and occupon::, ......~...~.~'~'~.~..~'. ............................... i .................................................................... - j 3. Nature of work {check which applicable): New Building ~ ................. AdditiOn ~x Alteration Repair .................. Removal .................. Demolition .................. Other Work (Describe) ...................................... 4. Estimated Cost ............. : .............................................. 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 occupancyi specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ...... .~.. .................. Rear .......... ~..~.. ............... Depth ........ ..,~...z]..../... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with olteretions or additions: Front ........ ...J~..~.! ................... Rear ....... .~...~../. .......... Depth ........ ~....~ .................. Height ............................ Number of Stories ............/. .................. 8. Dimensions of entire new construction: Front ....... .~...~ ...................... Rear ....... .~.. ................. Depth ........ ,~.1~. ......... Height .................... Number of Stories ......... ./. ........................................................................................................... 9. Size of lot: Front ...... ~.q..°...~. ............ Rear .. / o o / Depth ~ o ~ ' 10. Date of Purchase ...~.t4.~,2'...../~..{.~.l~..~. ..................... Nome of Former Owner ./~.~.~.~.~..~.~..¢~..~...,q~,~.~.~.~.~..~.... 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ...... ..~...q ............................................... 13. Name of Owner of premises../~.T.~'/.~,a;.~..~,4~/~. ........Address ..~/.~'~'~a?..~.~'.~...~.~. ............ Phone No. ~....(.~..: .,~..~.~..? Name of Architect ................. ?..~...~....~. ....................... Address ............................................ Phone No .................... Name of Contractor ............. ..-~...,q;C~......~... ......................... Address ............................................ Phone No .................... PLOT DIAGRAM Locate 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 interior or corner lot. STATE OF NE~ YORK/ / tee ......... ~:..c:., . .~ ..................... being duly sworn, deposes and says that he is the applicant a~ve named. He is the ................... ~~~..~ ........................... :, ....................................................... of said ~r or owners, and is duly authorized to pe~orm or h~e perfo~ed the ~id work and to ~ke ~d file this application; that all statements contained in this applicati~ are tree to ~e ~st of his knowl~ge a~ belief; and that the work will ~ ~rfor~d in the manner ~t fo~h in the applic~i~ fil~ therein. S~m to ~m ~ · s ~ ~ ~o~a~uHic, 8tare o~ ~e~ ~o~ ~o. 52-3041000 Commission Expires March 30, 1971