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Home My WebLink About5140-zFORM NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ~.o 5~0 z Do~. ....................... ./...~......,C..~C~ ....... ,1,ZZ Permission Is hereby granted to.'~ ~ ~ ~'/~' 7~ -J 1~ :3~E ,~C/4 /-te usu- aT premls s ioc(3te aT ....~.; .................... ~. ............................................................................................. · pursuant' to opplication doted /9 /~i*'~/~' ~ 19..7/~ and opproved by the Building Inspector. Building Inspector TOWN CLIIK'S OFFICI '~ ~ SOUTHOLD, N.Y. c~,~ ? Exomlned ..................... ~ .............,19...,~'./.. App, ed rm t No. IDUit(31r~ m~ec~or/ /'~ ,~ ,,x 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 bu_lldings on premises, relatior~ip to adjoining premise~ or public streets areas, and giving a cletafled description of layout of property must be drawn on the diagram whlch Is pprt of thle application. c. The work Covered bY this application may not be commenced before issuance of Bplldtng Permit. sh d. . UF~n approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit ~ all ~e kept on the premises available for inspection throughout the progre~ 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 pureuont to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lawl, Ordinances or .~eulations, for the construction of buildings, additions or alterations or for removal or demolition, as here n described. · applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. (Signature of applfcont, or ~zme, If a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant II a corporate, signature of duly authorized officer. .....................................(Name and e'o corporate tt~ce ) ~'~i'"i~ ................... i~i""; .................... ~re a ............. ..~....~. -7" /~ CU7-C~6~ S et nd Number .... ....~.. .......................... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. n,i, ,ng u,. and occuppnc,, .. . ....................................................... b. Intended use and ,"-',', ,',,',,',,-,,' 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .................. Removal .................. Demolition ............. ~. Other Work (Describe) ...~'..?...K'...~.......~.~...~...~....7~.. ....... 4. ,mated Co, ............. ............. ..... (to be paid on filing this application) 5. If dwelllng, 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 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 ...... ./../'L. ........ Number of Stories .................. ~..Z~..~T.~ ...................................................................................... 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ~.....:~.. of Former Owner ........................................................ ........................................ Z 11. Zone or use district in which premises are situated ...~....~...~.../..D .. 12. Does proposed construction violate any zoning law, ordinance or regulation a f · ~. ~-Z#YE~ COX /"~7' 13. N me o Owner of prem,ses ........................................ Address .......................................... No??...~'.-.....~...?....5".2-, Name of Architect ...................................................... Address ............................................ Phone No ..................... Nome of Contractor ........... ...~......~......'~...~.'~.. .................. Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bc~k dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, I ¢ ¢ COUNTY Of ................................ }' '~"~' ............................................................................................... oe~ng duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ~./~'4'/ - ~ ~A/~'~:~q ~'' (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 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 ~ ~, ................. l~,.. day of ........................... '~'~ '~'""~'"'"' 19"~'"/'" Notary Publi~,f/~:._~.~._/~ ....... ..~...N...:.b.h~.~.. County"~"'~'~.;;~-~"~'l~)-.'...;..r ............... ~ , ate of New York , No. 52-8125850, Suffolk ~'~m ~Xpires Ma~h 30, I~/~