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Home My WebLink About5317-z FOF, M NO. ~ TOWN 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) 5317 Z Permission is hereby granted to: ........... Ger~ld,..~:z~nez'.~ut. ........................... .................... Cutelt~ ............ ~ ........................ to ~l~d..z~/..ae~e ~,e~......(~tar~.).....~3,.d..~ .......................................................... ct premises loc~ted at ............. ~./~.'.~...~.~llt~h....~.~t~. ........................................................................ ........................................................ ~t~eho~-... ............................................................................. pursuc~c to application doted .............................. ,~, ......... ~ ........ , 19...~.$., and approved by the Building Inspector, Fee $...~.*.~0. ........... /-~¢ ~-- //' ~ ~ BUILDING DEPARTMENT /~./~/%~/ TOWN CLERK'S OFFICE ~ SOUTHOLD, N. Y. .......... ~proved ~ 19..~.' .... Pemit No ...... ~.~.~...~....~ .............. ....... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and 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 ofproperty 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 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 demolition, as herein described. The applicant agrees to comply with ali applicable laws, ordi nonces, building code, housing code, and regulations. (Signature of applicant, or name, if a corporation) ............................ ............................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer. .................. ......... '7-/.z... 1. Location of land on which proposed v~dr- will be done. Map No.: ................... _~.~ .........Lot No.......~. Street and Number ..../..~...~ ....... ~.~...~ ................ ~/ Municipality ' 2. State existing use and occupancy of~ded use and occupancy of proposed construction: a. Exisiting use and occupancy ............................. ,~.~-~'~"" .;~..~(,_.~/~ /-~'~' ..... ................... b. Intended use ondoccupancy ......... ~,~, ................ ;........~./~__T*~t~,~.~ ................... ~7~ ...................... 3. Nature of work (check which applicable): New Building ...... .~ ......Addition .................. Alteration ...... · ............ Repair .................. Removal .................. Demolition ................. _._Qther Work (Describe) ........................................ 4. Est mated Cost ............. ~ .......................................... Fee ~ ................................................................................. (to be paid on filing this application) $. If dwelling, number of dwelling units ............................ Number of dwelling unit~ on each floor ............................ If garage, number of c~rs ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ~ ........... 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 ...G...*.../~.... ....... Number of Stories ................. ~ ................................................................................ 9. Size of lot: Front ............~....~ .......... Rear .......... .~...~. ................. Depth ......... ~....~....~.. ........... 10. Date of Purch. ase ................ ~ ....................................... ,, ,~,,~,~ h~:~of~F[e~mer O~ner ........................................................ tr t n re are tut ....~.! .... ~ ....... 11. Zone or useds c whchp mses s aed ................................................. ~.~.) ....................................... 12. Does propased const ruction~jat,~y (zl~ ?,g,0~nance or ;,~u, ,_1~.~:/.... ~.,~51r.. -.u'.. ....................................... 13. Name of Owner of premise~em... ........... ~.....-~...~...Address ....~......(..~ ........... Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ...............~.! ................................... Address ............................................ Phone No ..................... PLOT DI^GRANt Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fram property lines. Give street an_.~LJzL~k number or description to show street and indicate whether interi~~.~, )[~: according deed, and names COUNTY OF ~:,a'~d['~L~C.......^..~ ......................... ........ (Nam~/o'f individual signing' application~ duly swam, deposes and says that he is the applicant 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 forth in the application filed therewith. Swom to before me this ~.,~- ........... ........ ...... ,,, ..,. - f 1.. . ........................ Notary Public, ~ ~L,,~~ ....... County ~ ~'~c:~ [~ (Signature of a~l~icar~) ' L/ / ELIZABETH ANN NEVILLE NOTARY PUBLIC, State of New Yor# No. 52.8125850, Suffolk Cou~t[ Term Expires Mereh