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Home My WebLink About5512-z FORM NO. 2 TOWN OF $OUTHOLD BUILDING DEFARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5512 Z Permission is hereby granted to: '. ........... ~.?,~....,l...?...~.~..,,..,.. ........................ at premises located at ........... ~r~...~.~..~r~J~....~tt.~[.~q~t~l:..~o~llblJ~t ................................................ ............................................... tle-~sm-r.!~ ............ Os'i~'~t..-..~ ,~,~ .................................................. pursuan¢ to application dated ................................. ~4~t~ ....... ~J.~ ..... , 19.,.~.~j., and app. rovecl by the Building Inspector. .~:~e ~.!.0..,.~ ........... FORll~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Disapproved o/c Ap ,,cat on No. ............ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in .nk and submitted in duplicate to the Buildin Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets c areas, and g~wng a detailed description of layout ofproperty must be drawn on the diagram which [s part of thru apphcatior c. The work covered by th~s application may not be commenced before issuance of Budding Permm d. Upon approval of th~s apphcation, the Building inspector will issue a Building Permit to the applicant Such perm 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 Occupanc shall have been granted by the Building Inspector APPLICATION IS HEREBY MADE to the Budding Department for the issuance of o Building Permit pursuant to th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other opphcable Laws, Ord.nances · Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, os herein describe, The apphcant agrees to comply with all apphcable laws, ordinances, building code, housing code, and regulations. Robert J. Douglass (Signature of applicant, or name, if a corporation) (Address of applicant) State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde ....................................... O.~r~"~ ..... 1~.'I.¢1.er ................................................................................................................. Name of owner of prem,ses ...... ~GJ}D~.$...,.T..t...~I. QI.~J~i/~I,~.~I .............................................................................................. If applicant is a corporate, s~gnature of duly authorized officer. (Name and t~tle of corporate officer) I. Locat.on of land on wh,ch proposed work will be done Map No ...~/..;J,~.~.g~ ...~..e.~..z:..~...o..~.... Lot No....!.~.....~....!..8.... Street and Number .......... 'Ne-tSO~"D~ ....... O'.e:J:e~t~,.....~J.,:~.~. ............................................................................. Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a Ex.siting use and occupancy ..... g.We'l'ltt~ ............................................................................................... b. Intended use and occupancy .......... S~:~..~.i::l:;h..~¢O~Z~....(.~f4:~:~8.~e.)..~1,1.i3~;]~g. ........................ 3. Nature of work (check which applicable) New Building .~ ....... Adder,on ...............Alteration ................ Repair .................. Removal .................. Demohtian .................. Other Work (Describe) ...................................... 4. Eshmated Cost ...... .1-~.f---GC)0 .................................... Fee ...!l.(~Og ........................................................................ (to be paid on fihng this application) 5. If dwelling, number of dwelhng umts .... ~O~ .......... Number of dwelhng un,ts on each floor .......................... If garage, number of cars ........................................................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..B...~.q.e..§..s..o...z~... 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ........................................................................................................... Dimensions of some structure with alterabons or additions: Front .................................... Rear ......................... Depth ................................ Height ............................ Number of Stories ............................. 8. Dimensions of entire new construction: Front ......... .~(} ..................... Rear .......... '~4) ............. Depth -.~0 ............... Height .................... Number of Stories ...~ .................................................................................. 9. Size of lot: Front .-~.OQ..,i- ............. Rear .......... .220..~ ............. Depth .....1~¢).../. 21.~. ..... 10. Date of Purchase ........................................................ Name of Former Owner ..................................................... 11. Zone or use distr~ct in which premises are situated .... ~J*,~ ..... !!A,?...cl:;L&t~ ............................................................... 12 Does proposed construchon violate any zoning law, ordinance or regulation> ............ ~) ......................................... 13. Name of Owner of premises .~la~.J.~...Dol~lS, s~ddress ................ 0z'.::LeZl. t .............. Phone No ................... Name of Architect .................................................... Address ............................................ Phone No .................. Name of Contractor ....... s~rne .................................... Address ...........................................Phone No ................ PLOT DIAGRAM Locate clearly and d,shnctly all buildings, whether existing or proposed, and red,cate all set-b~ck d~mens~ons fro property lines. Give street and block number or descnphon according to deed, and show street names and ind~ca whether interior or comer lot. STATE OF NEW YORK, IS S COUNTY OF ..$~.£~:i,~ .............~ ' ........................................... i~,~..~.o...D~I~.J~.1.a..~8 ............ being duly sworn, d~oses and says that he ~s the applica (Name of individual s~gning apphcahon) above named. He ~s the ..................................... g.~...~...b~e~ .......................................................................... (Contractor, agent, corporate off~cer, etc.) of sa~d owner or ~ners, and is duly authorized to perform or have performed the sa~d work and to make and f this application; that all statements contained in th~s apphcahon are true to the best of h~s knowledge and behef, a, that the work will be performed m the manner set forth m the application~led therewith ~ Swam to before me th~s // / f ~ _ ~o 52-81258~0, Suffolk Cou~y~ Term ~plres March ~, 19~