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Home My WebLink About4630-zTOWN OF SOUTHOLD BUILDING DIEPAKTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMrT Ci"HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL COMPLETION OF THE WORK XUTHORIZED) No. 4630 Z Permission is hereby granted to: at premises located ,pursuont to cLopllc~tion d~ted ,Building Inspector. FORM NO. ! ' TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. '~ 19....:~. Permit No. ,,,~.,,,~,, ,.~O ;) Approved ........................................ , .................... Appliclltion No..,,~,.,6,,,,~..? ......... ~ Disapproved a/c ........... ~.. ~ iD 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 port 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'hl 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 port for any purpose whatever until a Certificate of Occuoancv 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 buildit~gs, additions or alterations, or for removal or demolition, as herein described· The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. · Lloyd Hamilton (Signature of applicant, or name, if a corporation) Mattituck N.Y. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Owner - builder Name of owner of premises .....~..]r..O.~...~...a:.~..~..~..°..~.. .............................................................................................................. If applicant is a corporate, signature of duly authorized officer. J (Name and title of corporate officer) 1. Location of land on w,hlch proposed work will be done. Mop No.: ........... ~ ............ . ........... Lot No.: ..... IyO , .EJ.S Ba~e Beach R~.a.4. Ma.~.$ Street and Number .......... :. .................................................................. .~ ............................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ~.~].m...m..e.~..q.q.~..~g~l. ................ same with an addition on k- cottages b. Intended use and occupancy ................... ~ ........................................................................................................... 3.em'Nature of work (check which applicable): New Building .................. Addition ..... ~ ........ Alteration . .~... ............ ~ Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ................ 3.~O..~..~,a~L ................... Fee ...~.~...~.~ ...................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ..~'...(,.~,In~le.a,~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 ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .............. 1~ ................. Rear .......... %0 ............. Depth .....1.2 ............... Height .................... Number of Stories .......... .o..~..e. .............. ~ ...................................................................................... .................. ~ ....... Rear .................................... Depth ................................ 9. Size of lot: Front acera e 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ................................... .~.t..~..~.~...~1,$~.[ ........................... : .................. 12. Does proposed construction violate any zoning law, ordinance or regulation.;> .............. .~..~. ......................... 13. Name of Owner of premises ...~..~i~L~On .......... Address ....... -t4.~,:~:l;l~Ole .............. Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ..............s..~...~..e. .............................. Address ............................................ Phone No ..................... 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 corner lot. STATE OF NEW. YORK COUNTY OP ..~.1~.~,.~ ...... S.S. Lloyd Hamilton ................................................................................................. being du~y sworn, deposes ond says t~ he is the opplican~ (Nome of individual signing a~licotion) obove named. He is the owner - builder (Controctor, agent, co~orote 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 end belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this , f'l .................. 22.. _day of ............. ~..~'~i~ ................ , ~...2.0. /~~ -- ~ r ° ~-- ..... ,,~ ~.~_ P,.,-,~. fl,,_. '%).... : /I /Z. . ........ :,,r.'.:~oS ~ ................... ~ ~ ................... r~orary t'ubnc~, .I~.../.(Z/~'..~.~ County~ (Signature of applicant) [LIZABETH ANN NEVILLE NOTARY PUBLIC, State of NeW York No. 52-8125850, Sutfo~k Cou.~,ty Term Expires M~rch 30, 19,~