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Home My WebLink About4860-z FOlr,~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Yo BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISE~ UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 4860 Z Permission is hereby granted to: ~ ................. C~¢~,h~e ........................ , ................ to .......... B~;I~ .. ~.. ~d~ ~.t,~.~.. ~n*-~ ~.~, · -~..~.~.t~g. .................................................... at premises located at .................. ~/~.....~.~.~:~...~.,.*.~'. ........................................................ ........................................................... C~;~ ......... :~,...: ........................................................ pursuan,t to application dated ............................ ~'~. .......... ~l~..m.., 19...~., and approved by the Building Inspector, Fee $.....~.,.Q~ ......... Building Inspector FOR, M ' NO, ! TOWN O~ SOUTHOLO BUILDING IDEPARTMEN'll TOWN CLERK'S OFFICE $OUTHOLD, bi. Y. Application No ............................. Approved ........................................ , 19 ........ Permit No ............................. isapproved a/c ...................... ~ ...................... ;~....~'.~ ...... (Building Insp~/tor) APPLICATION FOR BUILDING pERMIT INSTRUCTIONS a. This application must be completeJy filled in by typewriter or in ihk and submitted in duplicate to the Building Inspector. c. The work covered by this application may not be commenced b~for~ issuance of Building Permit. d. Upon approval of this application the Building Inspector wi.,ll issue:a Building 'Permit to the oppHcant. Such permit shall be kept on the premises available for inspection throughout th~ progress of the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Ce~ificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the ~suance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New ~ork, ~nd o~her applicable Lows, Ordi~nces or Regulations, for the construction of buildings additions or alterations, or (0r remove or demo t on, as here n described. The applicant agrees to comply with all applicable laws, ordinanc~ buildh~g code, hous~de, and regulations. (Signature cf a~licant, or nam~ if a corporation) State whether applicant is owner, lessee, agent, architect, engineer, genera! contracfor, electrician, plumber or builder. < ' .~0. ~..' '~ ¢'-~ /~ .,/ F~ ........... If applicant is a corporate, signature of duly authorized officer. (Name and title'of corporate officer) 1. L~ationof and on wh ch proposed work wi bedone Me-No' " ::, ~,M_. '~'~ ~, ~ . . ....... ~_~~X~"'~: ........... ,~. .......................... Stre~ and Number ../.~.L~...¢...~...;} ....................... .................... ........ ..................................... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a, Existing use and ~cupancy .................................................. , ................ a..,.~r~ .............................................. b. Intended use ond occuponc, 3. Nature of wo~k (check whici~ applicable): New Building .................. Addition .. . Alteration .............. ' .... Repair .................. _Rej~oval .................. Demolition .................. Other Work (Describe) ........................................ 4, Estlmat,d Cost ........... ~..~.1. ................................ Fe~; ...... ..~...?. ...... .~... ........................................................... , ....... (to be paid on filing this application) 5. I.r' dwelling, number al: dwelling units ......... d ................. 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 ......................... 1.4 HeDimensi°nSght /.~..°f ~xistirlg~ st'ructureS,Number ofif anY:S[o F,On~es '" "~'""~'~' ............... Rear ..~../.'~ ....................... · . Depth ....~....~. ........... · 7. Dimensions of same. structure with alterations or additions: Front '~ ~ ~ Rear ~ ~' '~ '. Depth ......:$.'.Z ................... Height ../.~.:..i...~.. ........... Nurnber of Stories ......... ..~...--. ................. 8. Dimensions of entire new construction: Front ........ ~..~ ..................... ~ ! //~ Rear ..... ~. .................... Depth ..,..:...- ............ Height ..~./~.~ ......... Number of Stories . ../.. ............................................................................. 9. Size of lot: Front ..... ....... ~'Leclr ....... ........ ........ Depth ..... ]...'~...~.......~..~. ,~ 10. Date of Purchase ...... /.~..~...~.. ............. Name of Former Owner~.~....~..R..~....~.~.~%.~..~.'~..!J~ 11. Zone or use district in which premises are situated ................................................. ~..~, ............................................. 12. Does proposed construct;on ~iol~te any zoning law, ordinance or regulation? ....... ...~....~... ........................................... 13. Nome of O~ ~.,,r of prem,s~,...~../~/~ress ..~/~..':.~....,.~..'~........ Phone No ................... Name of Architect ...................................................... Address Phone No. ' Name of Contractor .................................................... Address ............................................ Phone No ..................... PLOT DIAGRAM gacate clearly and distinctly all buildings, whether existing or proposed,' and indicate all set-back dimensions from property lines. Give ~tre~t and block number or description according to deed, and show street names and indicm'e whether interior or corner Jot. STATE OF NEW~,Y-'~P~, ., COtJNTY OF ..,~,,.;[~/;~..!.;L.,....c--~Z....~~''~' ,,~ ..................... 1.,¢.~,.:~ ...... ~,.~--.,, .............. be,~ duly ~orn d~oses and says that he is the applicant (Name of md~wdual signing application) ~ ~ . above named. He is the .... /~ ....................................... ::::::::::::::::::::::::::::::::::::::::::::::: ............... 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 cont,ained 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. Sworn to before me this ,,' ~ ,-'~ __ .................. ................ ...... , - ..... I/.¢ ............ ....................... --ommlsslon Expires March 30,