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Home My WebLink About5492-zTOW~ OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, H. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5 192 Z Permission is hereby granted to: at premises located at ........~*-~!hl~:~lt~-.~.-e~-~l/~-.~e~[.e~e~h~ .................................................. pursuan~ to application dated: ..........' ........................ ~i~t~....~[ ....... , 19.....~.~ and approved by the Building Inspector. Fee $ ..... .~O.e~ ...... IrOB, M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT T~wN CLERK'S OFFICE SOUTHOLD, N. Y. Examln~~*~Jl~....~ ...... Approved ........................................ , 19 ........ Pemit No Disapproved a/c ......................................................................................... '... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Applicafioa No..~..,~..~'...~. ......... Sept 8 71 Date ................................................ , 19 ............ 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 public streets or areas, and giving a detailed description of layout ofproperty 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 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 regulations. Henry Pollock qo 1~-~ CO~. _ (Signature of applicant, or name, if a corporation) ' ~'o x. ~o~' Riverhead ( ~ 9 o / (Address of epplicent) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. OWNER · Henry ?ollock Name of owner Gf premises .................................................................................................................................................... ~ If applicant is a corporate, signature of duly authorized of icer. ~ (Name and title of corporate officer) ~ 1. Location of land on which proposed work will be done. Map No.: ......... ~ .......................... Lot No........,................~ ~ s -.t and ......... ...... .......................................................................... ~ ~ ~ ~ Municipali~ 2. State existing use and ~c~a~y of premiss and intended use and ~c~ncy of pr~ c~struct~: a. ~isiting use a~ ~c~ancy .............................. · ................................................................... .~ ................... b. Intend~ use and ~cu~y s~e ~ ~e~ ~o~e b~ 3. Nature of work (check which applicable): New 'Building X3QC Addition Alteration Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ~000 + - 1~OeO0 (to be paid on filing this application) Dorie 5. ~f dWeUing, number of dwelling units ............................ Number of dwelling units on eoch f~oor ............................ · - ~ garage, number ef c~rs ............................ . .. . 6~ . l.f business, commercial or mixed occupancy, specify nature and extent of each type of use ..bns:LD, e~.s ....... 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 orJ. e 9. Size of lot: Front ............................ Rear .................................... Depth ................................ ]0. Date of Purchase ........................................................ Name of Former Owner ............. ; .......................................... 11. Zone or use district in which premises are situated 12. Doe§ proposed construction violate any zoning law, ordinance or ragu at on? ..... TJ.Q ............................................. 13. Nome of Owner of premises Henry. Pellock Name of Architect ...................................................... Address ............................................ Phone No ..................... Nome of Contractor same .................................................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, ond indicate all set-bock 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. 9 STATE OF NEW YORK. , tS S COUNTY OF ....... ....... · ................................ .~..e...~.~.....~..o...]...~..o...c..~. ............................. being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the O~mer - buiZder (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 in this application are true to the best of his/le'i'6'~dge and belief; and that the work will be performed in the manner set forth in the application file(J,,therewith. / Sworn to before me this / .................. .......... __ ....... Notary Publi . Count7 ELIZABETH ANN NEVH. LE NOTARY PUBLIC, State of New York No. 52-8~25850, Suffolk Cou~t Term Expires March 30,