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Home My WebLink About4983-z FOEM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISE COMPLETION OF THE WORK AUTHORIZED) UNTIL FULL N? 4983 z Permission is hereby granted to: ..................... ~a]p~..~..~, .......... , ........... :: ..... to ........... ~.. az.. aa ~o~,~.-. ea...~ ea~. o~'-'~¢ts~ ~-t~" a'~er~ ..................... · ......... at premises located at .................. ~,.-'~,..--~&~"~y~l~. ~. ................. '~ ................................ ...................................................... ~..~a~...r~L0~a..~. .......... ~a~m~l: .................................. pursuant to application dated ........................... ~ ......... ~ ........ ;...., 19....~ and approved by the Building Inspector. Fee $.,~.eO0 ............ Building iti~pector TOWN OF souTHOLD BUILDING DEPARTMENT T~N CLERK'S OFFI~I '"' ....................................................... ..................................... ............................. .............................................. ........................... APPLICATION FOR BUILDING I'ERMI~ :te .......................... ....... ....... ,'lg.Z.O. .... INSTRUCTIONS ca. This ppplicotion must be completely filled In by typewriter ar in ink und submitted In duplicate to the b. Plot plan sbewing location of lot and of buildings on premlses, relationship to ad|alning premllee ac public areas, crud gi¥1ng a detailed description of layout of prt~er~/must be drawn on the dlc~nsm v~]¢h I$ part of thle ~ c. The work covered by this application may not be commenced b~fore issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. SUCh shall be kept on the premises available for inspection tJ~.roughout the progress of the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certlflcato af Occupancl~:: shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pureuant to the: Building Zone Ordinance of the Town of Southold, Suffolk County, New York, end other pppllcable La~, Ordinance= Regulations, for the construction of buildings, additions or al.terations, or for removal or dqmolltion, as herein dMcrlbed~ The applicant agrees to comply with all applicable laws, ordinances, building code, housij~i code, and regulations. ' (SlgnatJ/re cf applF'ant, or name, If a Cml~ratl~n) (Address of applicant) State whether applicant is owner, le~see, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premile~ ....JJp.~.l~,;I;'.~...~...J~e:iJ~'.~.t,...~..~JJ]~. ........................................................................................ 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. Map No.: ....... (~&p.t...J[,;Lcl. cl..~,~t;.t I. ot No.: ..JJ~.'J ............. Street and Number ............ ]J,/,q..~a.l~t;...E:Lcl. d..1~:r .......... ~e.t;.t,;L~uct' ................................................................. .~"~ 2. State existing use and occupancy of premises and intended use and occupancy of pmpaeed construction: 1 a. Existing use and occupancy ..... ~{i],~l,~i.D~ .......................................................................................................... b. Intended use and occupant', . ............ S. al~..~:L.t,h..s~Z~.~d~;J,t,~.Gll ................................................................ 3. Nature of work (check which applicable): New Building .................. Addition .......~ .... Alteration .~,~ ........ Repair .................. Removal .................. Demolition .................. Other Work (Describe) .................................... 4. Estimated Cost ...........~J:).O...+. .................................... Fee ...~..e..O..0. .......................................................................... (to be paid on fi!lng this application) 5. If dwelllng, number of dwelling units ...O~.e ................... Number of dwelling units on each floor ....................... If garage, number of - ' ' ' cars . . . , . 6. If business, commercial or mixed occupanCY,,~ sl~ecify 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 const~fi~n: Front .......... : .......... :.~..~ ........ Rear ............................ Depth ........................ Height .................... Number ~'f:~tories ...................................................................................................................... 9. Size at: lot: Front ............ lJ~[<) ......... Rear ................................... Depth ...... .1~,0 ................... ]0. Date of Purchase ........................................................ Name of Former Owner ....................................................... ] 1. Zone or use district in which premises are situated ....... .q~,.a...C].;J~,t; ........................................................................... 12. D~es proposed construction violate any zoning law, ordinance or regulation? .............. ]t~ ......................................... 13. Name of Owner of premises .TI..&..)I.~e,I~I.3 .......... Address .....~/*a.t;~,.1.~_~C ................ Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No .................... Name of Contractor ........... ~JJle. ............................... Address ............................................ Phone No .................... PLOT DIAGRAM Locate clearly and distinctly oll 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 indical'e whether interior or comer lot. ? STATE OF NEW YORK, tee COUNTY OF ..... ~1~.£~ir ..........~"~' .............................................. ~l.~'~l.Z'~t,.~13e,],~. ............... .being duly sworn, deposes and says that he is the appJicant (Name of individual signing application) above named. He is the ......................................... .O..~..~.q~.. ........................................... j ........................................................ (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..b~fore me this ............... :.....,d,ay of ..... .......... , /~ 1/*. _l..--~/. ! I. . 'I ~ ~/1// .... ..,~.:..:..~...._u~..~....-~..r........~...~ .......................... hlotar'/Public[,~il.~~../.../~.. Coun~t~l~ (Sign6ture of applicant) /? ..... _ELIZABETH ~NN NEVILLE V NOTARY PUBLIC, State of New York No: 52-8125550, Suffolk Term Expires ~rch ~0, ].9.~1