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Home My WebLink About5609-zTOWN OF SOUTHOLD BUILDING DEPAI~TMENT TOWN GLERK'$ OFFIGE SOUTHOLD, FI. Y. BUILDING PERMIT (THIS PERMIT MUST BE KE~:~I' ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.° 5609 Z Permission is hereby granted to: to Building Inspector. ,~ee $1..li~O~ ......... Building Inspecto/ pursuan¢ to application dated .............................. ~i~.e. ......... 4~ ........ , 19..~.t[., and approved by the at premises located at ...................... ~t~jl~.~..~ ....... t41t~[4~~) ............................. .................................................................. ~ ...... ~,. .............................................................. ~pprovea ........................................ , ........ ................................. Disapproved a/c ............................................................................................ TOWN OF $OUTHOLD TOWN CLERK'S OFFICE SOUTHOLD, N. Y. · INSTRUCTIONS 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 f~) 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. ~k 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 theBuildin{;I 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 lows, ord nantes; building code, housing cede, and regulations. (Signature of applicant, or name, if a corpor.ation) ~ ~ (Address of applicant) / State whether applicant is owner, lesse~6~.agent, architect, engineer, general contractor, electrician, plumber or builder. ......................................................... .................................................... 2 .......................... Nome of owner of premises ~~......~.P~... ......................... ~...~.~ .~. ..................... If applicant is a corporate, signature of duly authorized officer. .................. .........-7-//- ]. Location of land on which p_rop, osed w~rk will be done, Mo~;~No..'. ....................................... Lot No{...x ...................... Street and Number, ~i.~...(...~...~ .~...(~ (~,,~'.; ./.¢3.:...~... ...... ~ ....... /~ ~/'~ 0 Municipality 2. State existing use and occupancy of premises and intended use and occupancy of ~ropased construgtion: a. Exisiting use and occupancy · .~-3''-~ 4c?/Jgj/, ' ,,'~ ............. ~"~"(~'~'~"'"'"/~~ ....... ~"~ ..... b. Intended use and occupancy "~ .. Nature of work (check which applicable): New Building ..... ~ Addition .................. Alterotiom ................... Repair .................. Ren~val ................ .._ Demolition .................. Other Work (Describe) ........................................ Estimated Cost .............~...../.. <~.-..~...~......'~.. .................. Fee .......................................................................................... (to be paid on filing this application) If dwelling, number of dwelling units ............................ 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 Sto'~!es ..~ .............................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ....... ~ ........... Height ......... /...~.....~. ...... Number 0f~. Stories ..4~...,~....~... .............. 8. Dimensions of entire new Construction: Fron~ .................................... Rear ............................ Depth ........................ Height ...../~-~..~. ...... Number~x ,,~°f 'Stories ..... g~.,d~...~'~. ................................................... 9. Size of lot: Front ........~.~?...~...~'... Rear .................................... Depth ................................ 10. Date of Purchase: ....................................................... Nome of Former Owner ........................................................ 11. Zone or use di~t~ict.in, whi~h premises are situated ......... ~ ............................................................................ ~ ....... 12. Does proposed construction vi~,~any zoning law, ordinance or regulation? ...... phon.-N ..................... 13. Name of Owner of premises ~..~...~...~'.~..,.~.,~m~...~.Address.,.~..~'"'~'"~'~ Name of Architect ........... l..c..?.~_.~./..~'.~A~'~....~....~....~ress ............................................ Phone No ..................... Name of ContraS:tar .............~.~'~....,~.~..~..Address ............................................ Phone No ..................... ,',,',',./. PLOT DIAGRAM Locate clearly .0nd distinctly a~l bui|dings, 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 tarrier'lot. ~ t~L ~- - *'~ ' . . // . .................. ~-'~~t~ he is the app cant ... . above named. He is the ......................... ~ ............................................................... ; ....................... (Contractor, egret, co~orate officer, etc.) of said owner o~ owners, and is duly authorized to pe~Orm or h~e peffo~ed the said wor~ and to ~ke and file this a~lication; that all statements contained in this ~pplic~i~ are t~ to the be~ of his ~owl~e and belief; and that t~e wo~k will be performed in the manner set Swam to before me t~Js ~ vz.- _ ~ .~ / ~ .... ~ ) ~ Z"..~~.~.~,,~. .............. ~..~.~~ .... Not~ ~ubl~c,~.~~. Coun~f~elll (Signa~re of appl~cont~ / NOTkRY PUBLI~. State ~ New ~r~ ~ . No, 52-812~8~0. Suft01~ Counl Term Exp:res March 30, 1~