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Home My WebLink About5672-z FOF,,M NO. :B TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISE COMPLETION OF THE WORK AUTHORIZED) UNTIL FULL N? 5672 Z Permission is here'by granted to: .................... i~.~rev~ea~ ...................................... to ..... ;B~ilt~l .. e~..aet41~,~,~..~..,~& ~.t,~...~t.~e~...b~i.~tt~g ................................... at premises located at ......... te;~a..~et~vi;..~z~ ........................... ; ......................................................... ..................................................... C~t~t~'gtl~ ...... 'I~?i';~ ..................................................................... pursuQn~ to opp[icatlon dated ............................. ~)$(~.....:~ .............. , Ig....~.l,, and approved by the Building Inspector. Fee $....~,*'~0 ........... Building i~spector ~. TOWN OF SOUTHOLD ~ '~ c~ ~ ~ '~' ~-- BUILDING DE.t,A. RTMENT ~OWN CLERK S OFFICE S~THOLD, N.Y. /-~-~ Approved ........................................ 19 ........ Pemit No .....~ ............................... Application No.. . . ......... ;;.....~ APPLICATION FOR BUILDING PERMIT J INSTRUCTIONS "'~ '~ a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the '.~?~alng 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 pe~llit 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 cede, and regulations.'~ Henry ?ollok (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........ (Name and title of corporate officer) ......... 1. Location of land on which proposed work will be done. Map No.: ........... ~ ........................ Lot No....~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: 3. Nature of work (check which applicable): New Building .................. Addition ....~ .... Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ..........~yt~O0"~ ................................. Fee ..... '....~.e.(~.0. ....................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ...~OF~e ............... 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 ..... 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 ......b~.. ................ Height .................... Number of Stories ....D~ ........................................................................................................... 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ Nome of Former Owner ........................................................ 1 I. Zone or use district in which premises are situoted ........ .B......~:J:..S...~. ............................................................................ 12. Does proposed construction violate ony zoning Iow~ ordinance or regulation? ...~.O .................................................... 13. Nome of Owner of premises ..~D,~.~...~.Q~.],Q~ ...... LAddress .......]~..¥.~.~,~.~ ............... Phone No ..................... Name of Architect .......................................... i ........... Address ............................................ Phone No ..................... Name of C. ontroctor ..... [~ ..................................... Address ............................................ Phone No ..................... PLOT DIAGRAN[ Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-beck dimensions from property lines. Give street and block number or descripti°n according to deed, and show street names and indicate whether interior or comer lot. STATE OF NEW YORK, COUNTY OF ..~.~-f'-~O.]~ ............ ~ ' ...... ~ .................................... ~{~,~v..~>Oq.~... ....................... being duly sworn, deposes and says that he is the applicant (Name of indivi~f,~&r~'~g'nir~ ~-p~tion) above named. He is the ............................... ..0~..~.e.[...~...~..~.~,~..e.T.. ..................................................................................... (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 that the work will be performed in the manner set forth in the application filed therewith. __ Swam to before me this / ....... · ~6 day of . ~ N 0TA REyL' ZpAuB8~ ~, s~t ~ e N0 fE¥1N e[~ ,~o r i~ No. 52-8125850, Suffolk Coou~_ Term Expires March 30, I