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Home My WebLink About5293-z FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTN~ENT 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? 5293 Z Date ............ Permission is hereby granted to: · .~.~ ~.~;..~.~.~m ¥:~.~ ............................................... ........... ~a~....,.,9 .................................................... .......................... g~.le~ ..................... ~ ................. to .... D~:L1~.e.~.~`e~k~h~.us~(~c~.m~z~~b~.~kLn~.~.~hus~u~..~b~ at premises located at ........j~..~;.....?.~:.:~t;..;..~.]...}~.a,~..~...~i~e~....~/l~ .......................... .......................................................... .~,~-~ ¢.~;~.~e~'- ......... ~-~.., ............................................................. pursuan¢ to application dated .............................. ~JaT~ .......... .~[.~..~....., 19..~.~.., and approved by the Building Inspector. Fee ~ Building Inspector APProved FORM NO. 1 'T~OWN OF soUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. Application ............ Disapproved a/c ....~ ........................................................... ~... APPLICATION FOR BUILDING PERMIT Dote .......~..~..../...~..: ....................... ...., 19..~.../..... 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 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 part of this application. 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 issu~ 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 port 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 o Building Permit pursuant to the Building Zone Ordinance of the Town of Southold Suffolk County, New ~ork, ~.nd other applicable Laws, Ordinances or Regulations, for the construction of bui dings, additions or alterations, or !for removal or demo ilion, os hersln described. The applicant agrees to comply with all applicable laws, ordinances, J~ui~ing code, housing co~e,~nd regulations. ........... ...... ~..)a_tV re ,f app!ican~, nam~f, ~rpa.tlon) ............. ........ ( ddress ~ appllc~nt) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................ .......................................................................... :. ........................................................................... Name of owner of premises ................... .......................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title 'of corporate officer) Location of land on which proposed work will be ~ne Mop No.: ...i....~....~....~,~.~.. ............ Lot No.: ........................ Street and Number ..... ~.~.~..~..~j/~,.....~,O.~..O .............. ', ............. ~,..,~,, .~.,(,,~,,...,.~,'~/~ ......................... :Municipality State existing use and occupancy of premises and intended use a~d occupancy of proposed construction: a Existing use ond occupancy. ~J'~ ,S .~..~./.~..~.~.~..~..... '~'~'g .~.~.~ ~......~. ~..~./~.~..~... ............... b. ,ntendeduseondoccupan;'....~.~).C?.~u../-.~..{~..(~.,.~..'~"::....~..7..~.....~.....~.~..~. ........................................... 3. Nature of wo~k (check which applicable): New Building .................. Addition ................. Alteration ............. Repair .............. ~ Removal .................. Demolition .................. Other Work (Describe) .................................... 4. Estimated Cost ..... .."~...O~..~.........%"~.; ........................... Fee ........................................................................................ (to be paid on fi!lng this application) 5. If dwelling, number of dwelling units .......... :t;]'.;~ ........... 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 7. Dimen'sions of existing structures, if any: Front ............................ Rear ................................ Depth ................. Height ..... ./,..~....,~ ......... Number of Stories ........... ~ ................................................................................... Dimensions of same structure with alterations or additions: Front ...... .~...~... ................. Rear ...... ..~...~.. ........... Depth ..~'~...<D ................... Height ....,.'.< .m~.. ................ Number of Stories ...... /. ....................... 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height ..................... Number of Stories ..................................................................................................................... o ,ot: Depth 10. Date of Purchase .F.~.~/~'.~.Z)./"-~ ................................ J;~me of Former Owner ........................................................ 1L Zone or use district in which premises are situated ..... '~,~.~.~'/~..~-~..,,~ .................................................................. proposed constructlon violate any zoD, ing law, ordinance or regulation?, .......... ................... ~.~,~/...3,.) ..... 12. Does 13. Name of Owner of premises/~.~.~...~...~,~.O~,..Address~'~..~.~?~...~.~./,~/,~..x~,)~one N~.~.."..~...?...~..O Name of Architect ............................. ~..., .................... Address ............................................ Phone No ..................... Name of Contractor...~..,~,~I~.,~..~Z1//~' .~'~....Address ..... .~-../~/..~x~...-~.....~..¢hone PLOT Loca~e clearly ond distinctly all buildings, whether existing or p~sed, and indicate all set-back dimensions from property lines. Give street and block number or description according'"l~eed, and show street names and indicote whether interior or corner lot.~ S~T~~K,~_ ., t S.S r ................... ~~ ....... c~~ ...................... being duly sworn, d~oses and soys that he is the applicant (Na~e of individual ~ning a~lication) above named. He is 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 application are true to the best of his knowledge and belief; and that the work will be performed in the manner set fo~h in the application filed therewith. Sworn to before me this ;;; .-. Not No. 52-8i25850, Suffolk Cou~ Term Expires Ma~¢h 30, ~9~