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Home My WebLink About4963-z FOF,~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT fi.HIS PERMIT MUST BE KEPT ON THE PREMISE~ UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) : N? ~1963 Z O,~e ............ ~ ............ ~.~i~t~ ....... t~. ...... , ~9..,..~~ Permission is hereby granted to: ............. .~.~.t,...~;~,e~t,.e~. ................ : ................. ............ .G:~ ............ i ............... : ................. at premises located at ............ ,~.~l~..,.~t%~OO.~ ........................ ] .................... :.Z ................................... ............................................ :...~ee~o~t ......... ~,~., ...................................................................... pursua:n¢ to application dated .... .~]~: ........~S ......... [...., lg...~, and approved by the Building Inspector. .Fee $.,,~00,0 ............. Building Inspector BUILDING DEPARTMENT TOWN ~LERK~ ~H~, N. Y. ~,~...~., ........ ~...... ,,...~ ~,,=,on ~o..~..~.~.~.~ .... ,, , , .~g~.~. A~ ........................................ , 19 ........ Pe~lt ~o ...... Disappraveda/c .............................................................................................. APPLICATION FOR BUILDING PERMIT ................. Date .... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink und submitted in duplicate to the Building Inspector. b. Plot .pi.an showin~ I.oc.ation of lot and of building~ on premises, relationship to adjoining premlees or public streets or areas, aha g~vtng a detauea aescriptlon of layout of properly must be drawn on the diagram whlch Is part of ~hle application. c. The work covered by this application may not be commenced before i~uance of Building Permit. d. U apl=reval of this application, the Building Ir~pector will I~ue a Building Permit to the applicant. Such permit shall :be ~"~t on the premises available for inspection throughout the prngre~ of the work. e. No building shall be occupied or used in whole or in port for any purpoee 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 p~muont to the ,,Build!ng Zone. Ordinance of the Town of Southold, Suffolk County, New,~Gnd other applicable Lawt, Ordinances or Kegu~atlons, ?or the construction of buildings, additions or al.rotations, c~oval o_r demo tt on, 9.s her&In .deecrlbed. .... , _ , , ,?, .......... ~"'~' ¢^ddress of o.p~cont) / ' Staa~ether applicant i~,owner, le~see, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ........................... !..C..~....~...~...,.~....,. .............................................................................................. If applicant Is a corporate, s~gnature of duly authorized officer. (Name and title 'of corporate officer) I. Location of land on which prepared work will be done. Map No.: ........................................ Lot No.:/ ....................... Street and Number ..... ~...5.....'~,..Z..~'~.~,,..,~,,.~..,,~,,.....~,~,,,~,,. ................ ~,,,,,~,,,,~.,~.."7,/~.~..~..../~......~/.,. ,.~.... A,4un~c~,'ry "/ ..... 2.State existing use and occupancy of premlse&and,Jntended use and occupancy of propeeed comtnactlon: a. Existing usear~occupancy ..... /.~..(...~...~.d.~..~/r,.,~./__ ............................................................................................ ,nt..d. use and occur,on? ............................. ........................................ b. 3. Nature of walk (check which applicable): New Building ~ ................. Addition .......... Alteration ............. Repair ................ .. ~l~emovol .................. Demolition ................. Other Work (Describe) ...................................... 4. Est .~.ated Cost ..,w~...Z~.....~.....(~'... ............................... Fee / (to be paid on fi~ing 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 eochtype of use ......................... existing structures, if any: Front ......... "~.~..=.~,"C) C,,)Rear .......... . ."~... ................. Depth ....~."~ ~ ..... 7. Dimensions of Height ........................ Number of S~ories .............. ~...,~..Z.,,~... .................................................................... Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories .................... · ........... ,., /~ 8. Dimensions of entire new construction: Front .....~,....~...~.~/,, ................ Rear ........ ..'~.......~.... Depth ~ ~/ iht.. . / "C..-- ................................ He g .................. Number of Stones ............ ~.... .............................................. ~r ................................................. 9. Size Of lot: Front .......~.....~.'.__~..~.L;:.~ ~.~..__~.l;~e~r .......... ~........C~.'. .............. Depth ..... ~.....~....~..:...._~.,. ~ 10. Date of Purchase ........ ./..Z.?....').....''- ....................... Nome of Former Owner ..~..~../'....~..~....~....//../~;~./.~..~..~..._"';~' ;;'~'/" 1~' ''~ ] 1. Zone or use district in which premises are situated ............................................... .....~ .............................................. 12. Does proposed construction vioIGte ony.~onin~ Iow, ordinance or regulaJ:Jor~.~ .....~.~... .......................................... 13. Name of Owner of premises .~.....~g:::....~'..(5/.e...c....~'..../~..~.~../..Address ... '.~...~.....~..~..6...~...~Phon, No.)e'.~.....~....?..~..~. Name of Architect ............................................... Address ................ r~..,~ ...................... Phone No ..................... Name of Contractor ~./.~...~....~....~..../~....~....~...~......Address ..~./..~...Z..~..~... ............... Phone NZ~?..T.~.~' 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 according to deed, and show street names and indicate whether interior or comer lot. · STATE OF NEV~;~IJ~_,~ COUNTY OF ~..~..T. ......... J'"~,~"3 ....................... ~~....~' ............................. being duly sworn, d~es and soys t~ he is the applicant (Nome of individual signing application) ~ .~ o~ve named: He is the ~ ~~ (Contractor, ~t, co~omte officer, ~c.) of ~id ~ner or owners, and is duly authoriz~ to pe~orm or have pedo~ the said work and to ~ke ~d file this application; that alt statements contained in this application am t~ to the ~st of his kn~ledge a~ belief; and that the work will be performed in the manner set fo~h in the applicati~ filed therein. Swom ~ ~fore ~ ~is ~ _ ~ ' ~ ~ .................. ................ Term ~pires M~rch ~, 1