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Home My WebLink About5154-zTOWN OF SOUTHOLD 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) N? 515~ Z Permission is hereby granted to: ............ .t'l~.,...~.~.~J....~. .................................... ........................... tt~m~....~,Z~, ................... to ....... ~ ..mm..~lor~.....Ottax'~l~ .)...blgj ................................................................ at premises located at ........... ~Ji/~J..~...JJ~k~..~eJe..JJ~i~ ........................................................ ......................................... ~ ......... i~etlm.~ ......... tt~.~ ....................................... : ............................... pursuance to application dated '. .......................... ~. ............ ~J. ........... , 19,~.~...., and approved by the Building In-~pector. ~ TOWN OF soUTHOLD ~'~'~"~ $ ~2/(., ~ TOWN CLERK'S OFFICE ~THO~, N.Y. ~ ~ ~ /~~ .............. g .......... ,19....~ ~ -~; Appli~tion No.....~.L.~..~. ....... / ~ra~eO ........................................ , fY ........ ~e~lT ~ ...................... ~...,, ~..l i ~ , ~ Oi~p~ olc ...................................................... ~ ~ . ~ ~ ~ APPLICATION FOR BUILDING PERMrr ~ ate ...... .............................. ,19..2./..... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in d~plicate to the Building 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 of property must be drawn on the diagram which is pert of this application. c. The work covered by this application may not be commenced b,~fore 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 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 demotiHon, as herein described.' The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ~ .~,.........l~...~.~..r......~ ............................................ If applicant is a corporate, s~gnature of duly authorized officer. (Name and title 'of corporate officer) 1. Location of land on Which proposed work.will be do?e. Map No.: ........................................ Lot No.; ........................ Street and NUmber ..~...../.....~.....~.. ....... ~..-~-.~.~ ....... '....4~~....~..~..~. ...................... ~ / Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: - ~, b. Intended use and occupan:, ....~.---~.. ....................................................................................... 3. Nature of work (check which applicable): New Building ,~.. Addition .................. Alteration .................. Repair .................. Removal ~ .............. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ...~..~...~.~..:.........~ ........................... .Fee ..................................................................................... (to be paid on fi~ing this application) 5. If dwelllng, number of dwelling units ............................ Number .of dwelling units on each floor ...... ; ..................... If garage, number of cars ..................................................................... i ....................................................................... 6. If business, commercial or mixed occupancy/ specify nature and extent of each type of use ............................ z_~ 7. Dimensions of existingr 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 ......... O~.....~: ................. Rear .....~.....~.. ............... Depth ....~.....~.. ............ Height ....... ~... ........ Number of Stories ..... ./.. .................. ; .......................................................................................... 9. Siz f · ~, c~ / c~ · o lot. Front ...... ~ .... , Rear a~.......D.. ............... Depth ..../...~....~...!..-~...~'...~.~ / 10. Da · of Purchase ........... ~ ................................ Nome of F~rmer OwnerJ~...:.~~....~ 12. DOes proposed coD~ructk~n violate any zon ng aw, ordinance or reau at on:~ ~. 13. Name of Owner of oremises .. ~ ~.,I,1,~o, '~_~ ~ ..... '?z c- ·, ~,~ .................................. ,..-~ ...,~,;...,~.;,~.,,.--.~..~.~z~,~ ...... I~nooe NO. Name of Architect ...................................................... Address ............................................ Phone No . Name of Contractor .................................................... Address ............................................ Phone No ..................... PLOT DIAGPu~M . Locat.e clearly and distinctly oil bui d ngs, whether existing or proposed, and ind cate all set-back dimensions from p~rc?.,erty. I?e.s. Give street .and block number or description according to deed, and show street names and indicate wnerner,nter,ororcomer,ot. STATE OF 'NEW YORK,,. ~. ) ,, I Se / o o COUNTY Of.. ~./ZJ-~ ¢ ~' ' ' > ~.~ ............ :' · ................ . ~uly ~worn, d~es and iay~ tkt he is the applicant (Name of Individual s~ning appl~atlon) a~ve named. He is the ............ ~.....~. ................................... .~....... ................................. . .. ..... (~ntmctor, ~t, co~omte officer, etc.) of said owner or owners, and is duly authorized to perform or h~e perfo~ed the said work and to ~ke ~d file this application; that ali st~ements contained in this ~pli~l~ am tree 'to the ~st of his ~owledge and belief; and that the work will be perfo~ed in the manner ~t fo~h tn the appllcatl~ fll~ ther~lth. Swam ~fore me ~ls~_ _ ~ , ~ ~ ......... ~ ......... d~y of [~.~ .................. , 19~.....~ // / )~ - .... ,P_ .... ............. ~o aw ~umlc, ~~....~.....~. COU~ (Slg~oture of oppllcont) ~'" MARIO~ ~. REGENT f ~ ' ' / NOTARY PUBLIC, State of New Y0~ ~ No. 52-3233~20 Suffolk County ~em ~p~s ~rch ~ 1~