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Home My WebLink About5622-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT CI"HIS PEP-~IT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AU:THORIZED) No. 5622 Z Permission is hereby granted to: to ,Talin at premises located at .........~..~,~Tl..~(~.~ ................................................................................... ..................................................... C,~~ ............. .~.,.:~... .................................. : .......................... pursuom* to application dated ............................. ~V .......... ~JO ......... , 19.~.t/..., and approved by the Building Inspector. Building nspector ~t Exammed Approved TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE · SOUTHOLD, N. Y. t ,9.7../.. ^pp,icatlon ...... II .... ..... 19 ........ Pemit No .. D~sapproved a/c 7. .......................................................................................... INSTRUCTIONS a. Th~s apphcation must be completely filled in by typewriter or in mk and submitted in duphcate to the Buildm Inspector. b Plot plan showing location of lot and of buddings on premises, relationship to adlo~mng premises or public streets c areas, and g~wng a detazled description of layout of property must be drawn on the diagram which ~s port of th~s applicatior c. The work covered by th~s opphcotion may not be commenced before ~ssuance of Budding Permit. d. Upon approval of th~s application, the Building Inspector wdl ~ssue a Budding Permit to the applicant Such perm shall be kept on the premises avadable for inspection throughout the progress of the work. e. No budding shall be occupied or used m whole or ~n part for any purpose whatever until a Certificate of Occuponc shall have been granted by the Budding Inspector. APPLICATION IS HEREBY MADE to the Building Department for the ~ssuance of a Budding Permit pursuant to Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances, Regulations, for the construction of buddings, additions or alterations, or for removal or demoht~on, as hereto describe The apphcant agrees to comply w~th all apphcable lows, ordinances, building code, housing code, and regulations. \ (~gnature of applicant, or name, if a corporation) ddt I State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or budd Name of owner of premises ................................................................................................................................................ If apphcont ~s a corporate, signature of duly authorized officer. (Name and t~tle of corporate off,cer) 1 Location of land on which proposed work wdl be done Map No ...................................... Lot No Street and Num~e%?0...~.. .....~...~....~..¢...~.. ........ ~.~..,.~. ........................ .................. Municipality 2. State ex~sting use and occupancy of premises and ~ntended use and occupancy of proposed construction: a. Ex.siting use and occupancy ......................~?~.~..~..,~.;~.. ................................................................. b, Intended use and occupancy ........ ~.~ ...... ..... .............................................. Nature of work (check which applicable): New Building..................~ Addition . .......... ... ..... Alterobon .............. Repair .................. [~, oval ................. Demolit~or ................. Other Work (Describe) .................................... 4 Estimated Cost ...... .~..r.'.~4.~..('..~..L~.. ........................... Fee .................. ~..~ .......................................................... (to be pa~d on fihng this application) 5. If dwelhng, number of dwelling umts ............................ Number of dwelling umts on each floor .......................... If garage, number of cars ....................................................................................................................................... 6. If business, commercial or m~xed occupancy, specify nature and extent of each type of use ........................... 7 D~mensions of ex~stmg structures, ~f any. Front .........................Rear ................................ Depth ................ Height ........................ Number of Stones .............................................................................................................. Dimensions of same structure with alterations or additions: Front ................................... Rear ....................... Depth ................................ Height ........................... Number of Stones ............................... 8. Dimensions of entire new construction. Front ..... /..~..~.....~,.~. .......... Rear ../.'~..~2...~. ......... Depth ..~,.~.....~...... Height ...../.~..~.... Number'-'- of Stories ........ ./. .......................................................................................... 9. S~ze of lot: Front ............................ Rear .......................... Depth .............. .~'..~...."2,-~:~--.. 10 Date of Purchase ................................................... Nome of Former Owner ........................................................ 11 Zone or use d~strict in which premises are situated .................... ./..'JZ~.. ........................................................................ Does proposed construction violate any zomng law, ordinance or regulation? ........................................................ 13 Name of Owner of premise~..'~. /~ .'~..~ ..~'.¥:.~..~... Address ~&.~.~---~.~. ~ ....... Phone Nc~-,~.. ~..~.../.. Name of Architect ..................................................... Address ........................................... Phone No ..................... Name of Controctor .................................................... Address ........................................... Phone No .................... PLOT DIAGRAM Locate clearly and d~stmctly all buildings, whether existing or proposed, and indicate all set-back d~mens~ons from property lines G~ve street and block number or description according to deed, and show street names and indicate whether interior or corner lot duly sworn, d~/es~s a/f~l 'sSy~ that he STATE OF NEW---Y~I~, 1. S S COUNTY~F ~~. .............. ~' ~x~,~ ~ .......... ~..t.~.,~,~:....~~ ..................... being ~s the applicant \ /(Name of ind~wdual s~gning application) above named.W He ~s 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 in this apphcation are true to the best af his knowledge and behef, and tha~ the work will be performed in the manner set forth in the application filed therewith. Sworn to before me th~s - / ...... ...... v%_°'_ : " , _.___ ...... ............................