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Home My WebLink About4761-z l~OR~1 NO. ~ TOWN OF $OUTHO~.D BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISI~$ UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 761 Z Permission is hereby granted to: .............. ~ ~.t~...C~wo~ ~ ................. ................... ~'~r~..;:!o~k...~ 0~6:3 ......... ,~ ................. to .............. DU~I~'"~" '~t ~'~:~'~; :t ~" ¥J~¥' '~ ~ ~.~ ~'~' ~'~'~ "~i~'~ ~'~flt"~'al~[a'~ ........................ at premises located at ..... t~.~ ~.OU;gg~ :~-~;~ ~,~ ................................................................ ........................................................... Sou.f,h ¢~i~ ......... ~,.~;, ............................................................... pursuan¢ to application dated .......... ,~.~;[~...~(~..~¢~.~.~.,.~/...~J) ................ , 19..~/0., and approved by the Building Inspector. Fee $.....5~,.Q0 .......... Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN ¢:LERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 19 ........ Permit No. /'/7 ~/' ~ Disapproved o/c .................................................................. Application No. ~ ~/ (' ~. ~' APPLICATION FOR BUILDING PERMIT Oote ......................... ....... ........... , INSTRUCTIONS o. 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 odjo n ng prem ses or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part 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 o 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 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 buildings, 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 rergulations. (Signature of applicant, or nome, if o corporotlon) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........................................ Z: cz e . ............................................................................................................................................ Name of owner of premises ........ ~.~T.;Lg.T~ .C..9.1P~QI~Q~.I~.I,~. ............................................................................................ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Location of land on which proposed work will be done. Map No.: ...~ ............................. Lot No.: ....... :]EX~ .......... ~ Stre~,.~ond Number ...................... ~/~'/ ~ //.~ 7Z ~'- ~ Municipality ......... State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ......... .C]-..~f~,],~,,~T~-~...~.,~.~..~,~.~.~.OR.y.....~!,~.~,~]:l~ ............................................ same with add$.tion on accessor Buildin b. Intended use and occupancy ................................................................................................................ ~ .......... 3. Nature of work (check which applicable): New Building Addition ~ .................................... Alteration .................. Repair ......... ~ ..... Removal .................. Demolition .................. Other Work (Describe) ........................................ ~4. Estimated Cost ..'~j.~.:...~..c~.. ..................................... Fee ...~...~.,.Q~). ........................................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ......~..o...zJ...e. .............. 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 .....s...~..o..z'...a:j~..e. ....... 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 .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 1 I. Zone or use district in which premises are situated "~k" ~L~LSt: 12. Does proposed construction violate any zoning law, ordinance or regu at on:~ ~Q - 1 ........... ~:J'~ ......... J~'""'" '?i ~' ...... 13. Name of Owner of premises~.........C..q.~.~.l,J.q.Q13~.~...Address .~.~.l.......~..e.D,~....~..g,.~...s..o.D.. ]JB~o....i~.*.~.*. ....... Name of Architect ........... ........................................... Address ............................................ Phone No ..................... Name of Contractor .................................................... 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'S, and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW.YORK,,L COUNTY OF ..~ .~.....x~...L~..C~... ........ ................................... ~..-O.~Z. b6.~'-.~.......<~..~'..,~ .................. being duly sworn, deposes and s~ys t~t he is the applicant (Name of individual signing application) a~ve named. H~ ............................................................................................................................ (Contractor, agar, co~orate officer, ~c.) of said owner or ownem, and is duly authorized to perform or have perfo~ed the said work and to ~ke and file this application; that all statements contained in this application are tree to the best of his ~owledge and belief; and that the work will be performed in the manner ~t fo~h in the applicati~ filed ther~ith. Swam ~m ~ this · ......... , . ....... , Nota~ Public, .......~.~ ....... Coun~ (Signature of applicant)