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Home My WebLink About4652-z FOI~I NO. ~ TOWN OF iSOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT oN THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.o (1652 Z Permission is hereby granted to: ............ 1q~.3.~I~ ..&..Z~ ~J~e~....~ .......... .................... ~....1~...~.......~.~. ........................ to .............. ~...~?..~...~...~ ............. ;. ............... i ....................... at premises located at ....................... .~.l~t~...~...~.~l~..~..~$..J~l~...~....~...~.~...~..~. ........................ i ...... .......................................... ~ltt~..D;ir~L~e.t..... I~.~Lttl~Ik :...~[,][ ~ ................................. :....,..:... pursuor~t to application dated ................. : .......... ]1~ ......... ~ ............ , 19...~, and approved by the . udd~ng Inspector. Fee ,. ......... I Z ~- '~' C)©" ¢_.. "% -- Pia'f d L MAP 0I-] LAT-,Ii: /- ~r MATTITLJ TOWN CLERK'S OFFICE ~om*ed ........... ~ ............ I ............. . ~.~.. ,',~,~otion No...~.~. ........ ........................................... ~ ............ ......................... ~.....~ ~~ ~Y/~,/?~ , .....~ ............ ~.....~ ,~,/~ (~oil~ing I~ctoO APPLICATION FOR BUILDING PERMI1 ~: Date ........ ..~..~ ,.,.~ ............................ 19..~..~:~... ~ 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 pu~blic streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of ~s 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 have been granted by the Building Inspector. APPLICAq~ION iS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the i~uildlng Zone. Or.dinance of the Town of Southald, ~uffolk County,, New York, and other applicable Laws, Ordinances or eau arians, ?or the construction of buildings,/additlens or c/Iterati~l~s or for removal or demolition, as here n descr bed The applicant agrees to comply with all aPphcoble laws, ordinanc~s~ building c~, housing code, and regulations. (Signaturelof applicant, ar name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a co~orate, signature of duly authorized officer. 1. ~ation of land on ~ich pr~ed work will ~ done. Map No.: .............. ~...[ ................. Lot No.: .~ ................. 2. State exi~ing u~ and ~cu~n~ of pmmi~ and intended use and ~cu~ncy of p~os~ constructi~: b. Intend~ use and ~cu~ncv ~ ~ ~ ~ ~l ~ H. u,~ 3. Nature of work (check applicable): New Building ..... ddition .................. Alteration ....... · .......... Repair .................. Removal .................. Demolitian .................. Other Work (Describe) ........................................ 4. Estimated Cost ..........t.~...e...O..?..:..O..O.. ............................ Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units .......... ~.~......~.C. 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 ...... ~ .............. ~ 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 ...~....4,..~..~..:.... Number of Stories ........... ..'~.....t~....~. .............................................................................................. · ., 9. S~ze of lot: Front .....~..~._~ ? ................. Rear ....... Z......~. ................... Depth .............................. 10. Date of Purchase ........ JJ../J..7'* ..................................... Name of Former Owner4l..~ ~¢ ....................... t ~-~:e,vo~t ................... ~'~,/-: ....... 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ..e. kc.~....E:....~...'Y....z..~.4./..'.:'.¢.....c..?.?..[ ....... 13. Name of Owner of premises ..~...J..l~....e~...~....~...ff..~..~.~..Address ............................................ Phone No ..................... Name of Architect ..... .. n ,,,--- P~~ .............. g.......T; ....................... Address ............ ..-Z.i ............................ Phone No ..................... Name of Contractor ..j'.~.!..~..~...I./...~...~....~.~.~...~...~C...Address ............................................ Phone No.../~.....I'.L~..~,..~..~- 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 ~hether interior or corner lot. STATE OF NEW' YORK. lee ~1-,~'[' K COUN~ OF ...~.~.~Z. ............. ~a'~' ~ *'~ i~ ~ ~'~ being duly sworn, d~oses anc says t~t he is the applicant (Name of individual signing application) above named. He is the (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or h~ve performed the said work and to ~ke and file this application; that all statements contained in this applicationJ~re true to the best of his knowledge and belief; and that the work will be performed in the manner set fodh in the oppl~tion filed the~ith. Sworn t~before me this ~J ~ [ L ....... ........ .............. ................ .......... . .................. ............................... .... ............. . ............. . P-'lc t L_ · 5cole: 50': ~ TOWN l'vlAP OF [__At-:D $ UI;2VE.'Y~= D AT N.Y.