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Home My WebLink About4827-z FORM NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 4827 Z Permission is hereby granted to: .................. ~:~.~...~.a..~.e...s. ................................. ...................... .Sc~u.t~z~ d: ................... . ................. to ............. ]~t~dld..~.~..aema~...¢ato:~..b~l.~a~ ................................................. at premises located at ...................... ~/~.....[.~:L1~ ..~{~ ......................................................................... .......................................................... Seal. la.id. ........... ~:~., ........ , ..................................................... pursuan¢ to application dated ............................. ~r;tZJ3~ ......... ~m[~.i....., 19...~), and approved by the Building Inspector. FOR, M NO. I TOWN OF $oUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. Examined "~ ~ 19....?.~ Approved . .i ............ 19 ........ Permit No .... 1..¢[.....~....!...~' Disapproved a/c -'~.......~ ~ - ~'"-~.._..~.~-..~ .... . (Building Ins~pector) APPLICATION FOR BUILDING PERMI'r Date ........................ ~.1~.~ ............ ~c~ ......... , 19....~J0... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink und submitted ir1 duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining pram sas or pub c 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 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 port for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY NLa, DE to the Building Department for the issuance of a Build ng Perm t pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County New York cnd other opp cob e Laws, Ordinances or Regulations, for the construct on of bu dings, additions or a rotations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, houslng code, and regulations. Ju~Lua.,G&tea ............................................................... (Signature cf applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......................................... ~waer,..-...b~,~e,~ .................................................................................................................. Name of owner of premises .......... ~TM43..1.tt~..G&t~eli ............................................................................................................. If applicant is a corporate, s~gnature of duly authorized officer. (Name and title'of corporate officer) 1. L~ation of land on Which proposed work will be done. Map No.: .......... ~ ........................Lot No.: ........... ~ ....... Stree and Number ............... ~.....~..~ ......... ~ ..... ~n[n ............ Munici~ll~ 2. State existing use a~d occupancy of premises and intended use and occupancy of propos~ construction: a. Existing use and ~cupancy ........... ~.~ .................................................................................................... b. Intended use and ~cupanc, . ............. ~"~"~"~~.....(~e,..)..~ ........ 3. Nature of wink (check whici~ applicable): New Building ..... ~ ........Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ................. ~. ........................................ Fee .......................................................................................... (to be paid on fi~ing this application) 5. If dwelling, number of dwelling umts ............................ Number of dwelling units on each floor ............................ If garage, number of cars 6. If business, commercial or mixed occapancy, specify nature and extent of each type of use ............................ 7. Dimensions of exist!rig structures, if any: F~ont. ........................... Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Deplh ................................ Height ........................... Number of Stories ................................ 8. Dimensions of entire new construction: Front ........... .1.~.. .................... Rear ....... 'J~, ................ Depth ...~.0. ............... Height .................... Number of Stories ......... ~ ..................................................................................................... Size of lot: Front ............................ r~ear ................................... Depth ................................ Date of Purchase ........................................................ Name of Former Owner ........................................................ Zone or use district in which premises are situated ........... l~.J~.L.~.~,e,t, ....................................................................... Does proposed constructlon violate any zoning law, ordinance or regulation? ........... lJ.G ............................................ Name of Owner of premises _~T~l~l......g.&t, e3 ........ Address ......... ~1~13.t,~.O.~I. ............... Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ............ ~&~ne .............................. Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly ond distinctly all buildings, whether existing or proposed, ~nd indicate all set-back dimensions from property lines. Give street end block number or descriptlon according to deed, and show street names and indicate whether interior or corner Jot. / : 9, 10. 11. 12. 13. STATE OF NEW YORK. I, ,. ,. COUNTY Of ....... .~1~]~ ....... $ ~'~' .................................. i~'~.~'-'~= .................................. being duly sworn, deposes and says that he is the appJicant (Name of ina'/~a'~ s~gni'~]~pplication) above nomad. He is the ...................... (}~It~"'~ ...................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to ~ke 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 fo~h in the application filed therewith~ Sworn to before me this ~ ~ n ~ ~].. day of ~ 7~ .................... ...... ,~ ......... ~ ....... : ......... , 19 ........ I · ~~ ............................. NOTARY PUBLIC, St~J~ oJ Nt~ J~[~ Term bpires ~ate~ ~ J~