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Home My WebLink About5190-zT0~14 OF $OUTHOLI) BUILDING DEPARTMENT TOW14 CLERK'S OFFICE SOUTHOLD, 14. Y. BUILDI14G PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL '~COMPLETION OF THE WORK AUTHORIZED) N.° 5190 Z Permission is hereby granted to: :....: ..... ~.ex~5~ ............ ~.X~ ............................. to .... ~1~$;t~.. &.. ~eem..f~,... (,~,ee ~...:~..~m.~...fe~..~f~. ~ .................. at premises located c~t ........ ;J~.~-.--.~l~--~ek---~r~,~lt' ................................................................ ......................................................... ~eee~e ......... ~,.~., ................................................................... pursuar~ to application dated .............................. ~llt~l~ ....... ,~t ..... , 19...~J., and approved by the Building Inspector. ~:ee $..JIo~O0- ........ ¥ - Building Inspector [ TOWN OF SOUTHOLD ~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, No ¥o Disapproved a/c ........ ~ ,' · '" ( uilding Inspec~;l~"'-'~7'~ APPLICATION FOR BUILDING FEIt, MI'[ Application No........~..,./...~.....~...~.. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink. und submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on prem!ses: mlation~ip to adjoining pmmlee~ or public streets or areas, and giving a deeailed description of layout of property must De arawn an tl~e diagram whlch Is part of ~hie application. c. The work covered by this application may nat be commenced before issuance of Building Permit. d. U on approval of this application, the Building Inspector will Issue a Building Perm t to the al~ollcant Such permit shall be ~e~t 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 purpoee 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 Bul d fig Permit punmant to the ~Build!_r~. Zone. O.KI. inance of t.~he T ,o~n..o.f. Southo!d., Suffolk C. ounty, New Y, ork, and other applicable I.av4, Ordlnoncee or r~egu,m,ons, rot me construcT*on or OUllaJngs, add tons or alterat OhS, or tar removal or demolition, al her~in de~:rJbed. The applicant agrees to comply with all applicable laws, ordinances, building code~ouslng code, and regulations. ~1 (Signature cf appllc6nt, ? nam~e,-If a corgGlatlon) "' ( ddress o? applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant Is a corporate, slgnature of duly authorized officer. ~ (Name and title 'of co~orote offlcer) I. Location of land on ~rk wlR~d~o~Map No.: ............... ~ ................ ~.. I.ot No.: ...' ..................... ~' 2. State ,xistln~ us~'a~. ~1 occu~n~'~ of I:~ll.~a~j.~Le~d~~ occ.upan~,~y, lof prop,ed construction: a. Existing use and occup]ncy ......... ,...4.....~.~.~,......~........ ~...~ ................ ~. Repair ............ ...~'~ln~q~l~. ................Demolition ............... ..[~her Work (Describe)/..,.~;.~,~. ...... ~: ...... -. ~ ~ ~ - ~- ~ 4. ~t matea ~t ....~ .................................................. ~ee ...... ~ ............................................................................ ~ (to be paid on filing this application) 5. If dwelling, number of dwelling uni~ ..... ~ ....... ~.. ............. Number of dwelling units on ~ch flor ............................ If garage, numar of cam ............................................... ,j~; ................................................................. .......................... 6. If business, commercial or mixed ~cupancy, spEci~nature and extent of ~ch ~e of Use ............................ 7. Dimension~, existing structure, if any: Front .T..~...~. ........... Rear ...... .~..~ ................ ;. ~Pth Height .....~ ................ Numar of Stori~ ...... {....~ ................................................................................................. Dimensions of ~rne structure wi~ ol~rotions or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories .............................. :. 8. Dimensions of entire new construction: ~ront .................................... Rear ............................ D~th ........................ ,e~,~, .................... I~m~, o~ S~ori., ............................................................................... : ...................... : ............... 9. Size of lot: Front ....~.~..~.~..~Rear .................................... Depth .................. ~...: .... ' ,0.o, ............................ o,me, 1~. Zone or use district in which premis~ are situated ...~..~;~...~.~.~..~.~.~.~.~ ........................... 12. ~es propos~ construction ~t~ any zo~ law, atonce o~ regulation? ............................................................ Name of Archit~t ...................................................... A~ress ............................................ Phone No ..................... N.~. of Con,,oc,o~..~.~..~ ........................... *~,.,, ~&.~..~ ..................... ,~ne No .................... PLOT DIAGRAM Locate clearly and distinctly all buildings, 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 comer lot. STATE OF N~R~ te5 ................................ ~~..~...~.~....being duly sworn, d~es and says t~ he is the applicant (Contractor, ~t, co,orate officer, etc.) of said owner or owners, and is duly authoriz~ to perform or ~ve pe~med the said Work a~ to ~ke and file th s appl cation; that all statements contained in this appliCation a~ t~ to the best of his knowledge and ~lief; and that the work will be performed in the manner set fo~h in the appliCati~ filed the~ith. Sworn to ~fore me this ~ ~0. 52-8125850, Suffolk Term Expir~ ~rch ~, J~