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Home My WebLink About5457-z I~OR~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT CFHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°. 5~157 Z o~. ............................ :.~e.~ .:...t, *., ,~..~t. Permission is hereby gronted to: premises located ot .......:~dlD~..tjjil[ ......... .--.~ll!~llhILe.-~-~a.~..~lllll~l~l~ ................................ ......................................... ~J¢,*.-~. ............. e~,ai~ttJ ....... ~,.~ ................................... pursuant to opplicotion d~ted ............................... ~ ....... ~.: ....... , 19.~1~.., and approved by the Building Impector. Pee S..ffll~O~s ............ TOWN OF SOUTHOLD BUILDING DEPARTMENT ~ ~/~.~,~//.~ ' d/~,,~-~ TOWN CLERK'S OFFICE ~.~/~ :-~ ~ ~'~' SOUTHOLD, N. Y. ~od ~.....~..~ ..... , ~.~.~.. ~,~,on~:..~.~..~ .......... ~..~ 1~7~- ....................... , APPLICATION FOR BUILDING PERMg~':¢~;~_____.,/ Date ....... '"'.....--a.t../.4. ................. 19:L[. .... I~STRHCTIO~$ o. Thi~ opplic~tion must be completely fill*d in by ~pewriter or in ink ond submitted in duplic*I~ to th~ Buildino I n~p~ctor .... b. Plo~ plon showin~ Ioc~tion o{ lot *nd of buildinos on premises, relationship to odjoinino premises or public ~tr~*t~ ~roos, ondgivin~ ~ det~il~ d~scription o{ layout ofprop~r~ must be drown on the di~orom which c. The work cowrod by this opplic~tion m~y not be commo~od be{ore issuonce o{ 8uildin~ P~rmit. d. ~pon ~pp~ol of this ~pplic~tion, th~ Buildin~ Inspector will issuo ~ Buildin~ Permit to th* opplic~nt. Such p~rmlt sh~ll bo k~pt on th~ praises ~voilablo for inspection throughout th~ pro~ms~ of th~ work. e. ~o-~ sh~ll b~ ~cupied or usod in whole or in p*~ for any purpose whoever until a sh~ll h~ve b~en ~mntod by the Buildino 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 ~ Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. ni~using code, and regulations. The applicant agrees to comply with all applicable laws, ordina .... 7(f ii~ on) , ................. ................. 7' (Address of applicant) ~' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..... . ._/~'..~. t:~.d/( ./~'......~'~......~.../1~.~..~ f:: .~.~. L~. ¢ If applicant is a corporate, signature of duly authorized off' e. ~ ~/~-~ ~ 1L~ationof and on wh ~ pr~os~d work will be done. ~pNo.:..~ ................ (.:~..~-- Lot No. ...'".'" . ..... ' Street and Number .../~.~.~.~.~:....~ ......... ~'~.[...~ .............................................. :.[::::~[~ ' ~ ~ ~: ~ M.nicipali~ 2. State existing use and occupancy of premises and intended use and ~cupancy of proposed construction: ,. ~i.it,no ..e.n~.~n¢~ .......... ~..~..~:..~..4.'..~.~ ........ ~ ....... ~.~>~:(,~.~:,~..~ ........ b. i~t~.dod .se ~.~ ~¢.P~W ........ ~Z....~..~....~ .......... ~. ................ ; ........... 3. Nature of work (check which applicable): New Building .................. Addition ...... ff. ......... Alteration ..... 'i ............ Repair .................. Removal .................. Demolitio~ ......... .i....;.. Other. Work (Describe) ........................................ 4. Estimated Cost ............. ..~.J..e~......~.. ....... : ....... ii .......... Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, number of cars ............................................................................................................................................. 6. If business, commercial or a~ixed occupancy, specJ? nature and extent of each type of use ............................ 7. D mens ons of ex st ng structu~r?r'~y: 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 ......... ~....Cd.. ........... Rear .............. ~......d. ............. Depth ......... /.....~.~....*~.. ...... 10. Dote of Purchase ............ ./~/~.....~. ............................. Nome Of Former Owner ....... .~.~:...~..q~.. ........................... 11. Zone or use district in which premises are situated ....... ~.~'~.~.~...~..&-~...~....7.~..~...~. .................................................. 12. Does proposed construction violate.any zoning law, ordinance or.regulation? ....~C). .............................................. 13. Name of Owner of premises .~'...~...~....C~'.~'~"~..o. .......... Address t~z~......~.....~... ....... Phone No. ~...~..~.:.../.~...~/~ 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 and block number or~,description according to deed, and show street names and indicate whether interior or comer lot. /~'0/('O ~q STATE O~/NEW YORK, /7 ~¢ ¢ . L! ~-~- ! o - .... ........ ............ ............. bei du y ' (Name of ind,~,idual sig~ing application) /?.r ' ,- )/uo , swam, deposes and says that heis the applicant above named. He is the .... (Contractor, agent, corporate 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 Jn this application are true to the best of his knowledge and belief; and tha~ the work will be performed in the manner set forth in the application, filed therewith. Swam to before me this ........................ day of ............................................ , 19 ........ Notary Public, . ........................................................... Coun~ (Signature of applicant)