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Home My WebLink About5311-z FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PEIU~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 5311 Z Permission is hereby granted to: ............. lia.*,.t,~.t, aek ............................................. at premises located at ..J'l/~....-~..JJ~J ....................................................................................... ..................................................... te~cm/e .............. 2~'~ .................................................................. pursuan¢ to application dated ............................... ~.....:J.~ ........... , 19..~'.'~.., and approved by the Building Inspector. APPLICATION FOR BUILDING PERMIT Date ..................... ~ly.../.?. ............... , 19...~2..... INSTRUCTIO, NS . . a. This application must be completely filled in by typewriter or in iak, and lubmJtted Jn ckipllcatl to the Building Inspector. b. Plot .pi?n shc~, ]njj I,oc?tion' o.f. lot ~ of.bu.lldingl .on pre.m,ises; r~latlon~, ip to adjolnlog I:)reml~l Qr L~Jic lfreets or areal, Gna giving o i~'Oll~a (~eecrlptlon at layout at property must oe orawn on the diagram whlch il I~ff Of ~fl~l al:qaJlcatJon. c. The work covered by this application may not be commenced before issuance of Building Permit. d. U ppf shall be Ut on~thr°~al of this appllcatl~, 1~h~llldlng. Inspector will IssUe aB4~i, ld~ Permit to tbe applicant. ~uch permit premises avallable-fbr Jr~l~tion throughout the pragr~s at.the ~v0rk. e. No building shall be occupied or used In whole or In part for any purpose whatever until a Clrtlflcato 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 ng Permit laU~aant to the RBUild!r~.. Zone. O.rfl, inance, of the To.,~ .o,f. Southold, Suffolk County, New York, and other applicable Lawl, OldinanCe~ or egwat,ons, mr The construction aT au,,aings, additions or alterations, or for removal ar demo t on, as heroin, dmcrlbed · ~. o,p,,co., ~.. to ~om,,, .,t~ o,, o,,,,co,,. ,~,. o~,...,.~,,..0 c... ~...,.0 ~_~,. o.~ .~,.t,--,. ' . ........... ,~...'.~..~-~~..: ...... ' ................. (Signature cf appll~nt, or name, If a ceq~ratle~) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber ar builder. Name of owner of premises ................................................................................................................................................... If applicant is a corporate, signature of duly authorized officer. ~ (Name and title 'of corporate officer) 1. Location of land on which propaeed work will be done. Map No.: ................ ; ....................... Lot No.: ........................ Street and Number . ~ ....... IL .................................................................................................................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of prpposed construction: a. Existing use and occupancy ................................................................................................................................... b. Intended use and occupono J~JJOe ileeld~ll~l"l;ePI 3. Nature of wo~k (check which applicable): New Building ......... ~ ...... Addition .................. Alteration ............. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ....................................... 4. Estimated Cost ....... ~u~l~ll~l~:12~l.;.~.; ................... Fee ................... :.2 ................................................................... (to be paid on fi~ing this application) 5. If dwelling, number of dwelling units ........................... Number of dwelling units on each floor ..................... If garage, number of cars ................................................................................................................... ~l~p.,l.~.~j~ ........... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..l~l~L~ .............. 10, 11. 12. 13. 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~..t.~..w... Number of Stories ........ ,l~ ............................. : ............................................................................ Size of lot: Front ..... ~.~.~..~. ........... Rear .................................... Depth ................................ Date of Purchase ........................................................ Name of Former Owner ........................................................ Zone or use district in which premises are situated .................................................................................................... Does proposed construct;on violate any zoning law, ordinance or regulation? ............................................................ Name of Owner of premises ....~.0l~.~//tAl~l~...~.~.ll~....Address ............................................ Phone No ..................... ~ntract,,,~1~l 31. ~. .T.q~ Address .......................................... Phone No ................. :.. Name of .... ......... ~I~ ~eo. PLOT DIAG~M ~ate clearly and distinctly all buildings, whether existing or pr~, a~ indicate all ~t~k dimensions from pm~ lines. Give street and bilk nUmber or description according to d~, and ~ow stre~ nam~ a~ indicai'e ~he~er interior or comer lot. STATE OF NEW..Y4DJ)J~., 1 S.S. COUNTY OF ....~;;kq~,J~. ............. )' ......................... . .~...~...1..~..~......~.;.....~...1~.....1~.. ......... : .......................... being duly sworn, deposes and says that he is the applicant (Name of individual signing applicqtion) above named. He is the .............. :..'..~.~..~.~.~...I.?..?. ................................ :.!.~.~:Z' ......... ,.~..;....': .................................................... (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. County~e:.~'~r'~l~ (S~ature of applicant)