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Home My WebLink About5228-z FOR~ NO. ~ TOWN OF Sou'rHOLD 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.o 5228 Z Permission is hereby gronted to: to ....... J~..mm..emt .-~'~--~~ ............................................................................ at premises located at ................ ~Ii~.....-~....L ................~j~.~..~~ ..................... ............................................... J~..ll~.~e:l~..~e ................... l~t~tte~ ................................... pursuan¢ to application dated ....................... ~J~,J,.....~JJ~ .............. , 19...~]., and approved by the Building Inspector. Fee $ ..... .~e~te ...... ' ' Building Inspecto~x Approved ..................................... , D~sapproved a/c ..... l~O]~lYI l~IO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 19 ........Pem,t No .................................. Application No ............................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date April 13 19 71 INSTRUCTIONS a Th~s apphcat~on must be completely filled m by typewriter or ~n mk and submitted ~n duphcate to the Buddin, Inspector. b Plot plan show.ng location of lot and of buddings on premises, relationship to adjoining premmes or pubhc streets o areas, and gwmg a detailed description of layout ofproperty must be drawn on the d~agram which ~s part of thru application c. The work covered by th~s apphcation may not be commenced before ~ssuance of Budding Permit. d Upon approval of th~s apphcat~on, the Building Inspector w~ll ~ssue a Building Permit to the applicant Such permi shall be kept on the premises available for ~nspect~on throughout the progress of the work. e. No building shall be occupied or used m whole or m part for any purpose whatever until a Certificate of Occupanc' 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 th. Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o Regulations, for the construction of buildm§s, addmons or o~terat~ons, or for removal or demolmon, as herein describe, The apphcant agrees to comply with all apphcable laws, ordtnances, building code, housing code, and regulations. Edw Abits Contractor Inc (S~gnature of applicant, or name, if a corporation) Mattituck N.Y. (Address of applicant) State whether apphcant ~s owner, lessee, agent, architect, eng~r~eer, general contractor, electrician, plumber or budde~ .................................. .(~rne~ ~. h~.l_d~ .................................................................................................. Name of owner of premises .... .~..~.~....~.1~.$.~.~.....B.~...~.~.~.~.?.......~...~. .......................................................................................... if applicant ~s a corporate, signature of duly authorized officer. (Name and t~tle of corporate officer) 1. Location of land on which proposed work will be done. Map No ..... .D..?..~.~..~-O.?..~...?..~.....~.?.~Lot No. 21 Street and Number ............. ~.~.~r...~.~.O.~...~..~.~ ............ ~.~.f,~ ....... .~.~ ............................................. Municipality 2. State ex~stmg use and occupancy of premises and inCended use and occupancy of proposed construction' a Ex~s~ting use and occupancy ...... .Y..a. 9.0~/?...~....~.~...~. ............................................................................................ b. Intended use and occupancy ................ O~e...£,~m~b~:..cl4q~3b~l~ ................................................................ 3. Nature of work (check which applicable]. Now Budding .... ~ ....... Addition .................. Alteration ........... Repmr .................. Removal ................ Demolmor ................. Other Work (Describe) .................................... 4 Estimated Cost .........2DtD. O0..~+. ............................ Fee ....'l..0.~..C~....O. ....................................................................... (to be paid on filing this applicahon) 5. If dwelling, number of dwelling units ......... ~:[~. ........... Number of dwelling un,ts on each floor ....................... If garage, number of cars ......... 0:~,~ ................................................................................................................... 6 If business, commercial or m~xed occupancy, specify nature and extent of each type of use ......................... 7 Dimensions of ex~stmg structures, ~f any: Front ........................... Rear ................................ Depth .................... Height ........................ Number of Storms .......................................................................................................... Dimensions of same structure with alterations or additions: Front ....................................Rear ........................ Depth ............................... Height .......................... Number of Stories .......................... 8. D,mensions of ent,re new construction: Front .............. ~ ................. Rear ...... ~..~.. ................. Depth ..... 2.8 ............ Height .................... Number af Stories ....... 9~.'.~e ........................................................ 9. Size of lot' Front ...I~20 ............... Rear .............................. Depth ......~8.~. .................. 10 Date of Purchase .................................................... Name of Former Owner ..................................................... 11. Zone or use d~strict m which premises are s~tuated ....... tJJL.e...~tJ.s.t; .................................................................... 12. Does proposed construchon violate any zoning law, ordinance or regulation? ........... ~ ..................................... 13, Name of Owner of premises ..~.~'...~'tt,~..;~.Tt.¢ ....... Address ......... !..~..e:..l}.&$~..~.~ ............. Phone No ................... Name of Architect .................. ~Ba4~,e .................... Address ...........................................Phone No ................... Name of Contractor ..................... sa~le .................... Address .......................................... Phone No ................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ex.sting or proposed, and indicate all set-back dimensions fror property hnes. Gwe street and block number or descnpt~on according to deed, and show street names and indicat whether interior or corner lot -i ' ..... STATE OF NEW YORK, COUNTY OF ...... ~J~-.~.O-_'b_~' ......... j-S S ....................................... ~l,~;a~.~..J~:~t,~ ......................... being duly sworn, deposes and says that he is the apphc~ (Name of individual signing apphcat~on) above named He ~s the ........................... ~'~'l~,e;~...,,...b~:L'Lc~..~ .................................................................................... (Contractor, agent, corporate officer, etc ) of said owner or owners, and is duly authorized to perform or have performed the sa,d work and to make and this application; that all statements contained in th~s apphcation are true to the best of his knowledge and belief, tha~ the work wdl be performed in the manner set forth in the application filed therewith. Sworn to before me this .................. · ~. day of .............. ~. ..... ,~$~,], ........... , 19.....~.. N°tary Publ'c' 'Q'~' ~'~'4Lt ~' J~/~' ' '~'~/1~'~ u ~ ~! ..... ""; ....................... :....: . Co.n,,, ..................... ELIZABETH ANN NEVIELE NOTARY PUBLIC, State of New York Ne 52-8125850, Suffolk Term Exp~s March 30,