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Home My WebLink About5325-z ~0~ NO. :t 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) NV 5325 Z Permission is hereby granted to: .............. ~el~e~t.. ~mee~.&..~ge ................. ................... g~ ...... .l,,.~, ...................... to ..... ~,~L3.cL.Gr,...~ J.t~ J.~_.eu..ez~,s.t~g.. d. wL1, 3.:1.~ ......................................................... at premises located at ...... ~k~t..~l,..~i~O~....~,;~.£.&~.:....~l.~.~;..~ .................................................. .......................................... z~hl~®te ~..~e~d~ ...... g~el~ ...... J~ ~.~.~ ...................................... pursuant to application dated .......................... Arl)~...~r ........ 1.~, .......... , 19...~:~., and approved by the Building Inspector. Building Inspector 'rowH oF SOUTHOLD TOWN CLERK'S OFIqCl SOUTHOI,J), Ho ¥. APPLICATION FOR BUll,DING I~RMIT INSTRUCTIONS a. This application mUst be completely filled In by typewriter or in Ink and submitted in duplicate to the Building Impector. b. Plot plan s~wing location of lot ~ of buildings on premises, relationship to ocljo~nlng pmmlee~ or public streets or area~, and giving al dJl~lfled dsscrlptlan of layout of property must be drawn on the diagram which Il part of thle 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 Impector will Issue a Building Permit to the applicant. Such permit shall be kept an the premises available for Impectlan throughOut the progre~ of the work. e. Nc) building shall be occupied or used in whole or In part for any pu~oee whatever until a Certificate of Occupancy shall hav~ been grantedby the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of o Building Permit patient to the Building Zone Ordinance of the Town of Southold, Suffolk COunty, New York, and other applicable Laws, Ordinances or R~gulatlans for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all app icab· laws, ord nonces, bu Iding code, hOusing code, omi regulat ohs. (Signature of applicant, or name, If a corporation) ..................... oPP,l¢o.. ................ State whether applicant Is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...................... ~..~..~.4~ .................................................................................................................................................... Nome Of Owner of premllej ...~u~'.X......~....~,,~,~.G'~.,~2~..~. ,~. ....... /,/.~..~.~.~..~.. ............................................. If ~l~ant I~ a cm~e, ~lgna~m of du~ au~lz~ off,er. (~m a~ title 'of co~e offl~r) 1. ~atl~ of ld~ ~ ~icB ~ ~ will ~ ~e. M~p N~ ...... -v.'.',~... ~ ~ ........... ........ x '" '- ~ Mu~icl~ll~ ' ~. ,,,~e~~,'.~~.~x....~.~.~.~......¥..,. ,, - ~ ~, ....... 7' - ':' ........... Nature of wo~k (check which ap~ New Building .................. Addition .................. Alteration .................. Repair .................. ,~Removal .................. Demolition .................. ~ther Work (Describe) ........................................ (to be paid on fi~ing this application), 5. If dwe[llng, number of dwelling units ............ : ............... 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 use ............................ 7. Dimenslons of existing structures, if any: Front . ....... .'~.'..~ ........... Rear ...... ~..~...~.~ ................ Depth Height ..../..5. ............... Number of Stories ......... ./. ...................................................................................................... Dimensions of same structure with alter(=tigns or additions: Front ..... ~..,~. .......................... Rear ...~..../. ................... Depth ...~,.~ ........................ Height ..../m~ ................... Number of Stories ...... /. ........................ 8. Dimensions of entire new construction: Front ....... ~..J. ........................ Rear .....~..~.~ ................ He ght i .~.. ....... Number of Stories I .,. 11. Zone or use district in which premises are situated ....~4L,~.I~..~... .............................................................................. 12. Does proposed constructlon vioJate any zoning law, ordinance or regulation? .~.~....~..:..~.~.....~.~.~'.~E ...................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Nome of Contractor ..~ .....................................Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distir~ctly oil buildings, whether existing or proposed, and indicate all set-bock dimensions from property lines. Give street and blocR number or description according to deed, and show street names and indicate whether ~nterior or comer lot. STATE OF NEW Y. ORK lee COUNTY OF. .... ..~..~;~..~..~..~ ,,... ,. J ~'~' .................. ~~; ....................... being duly sworn, deposes and says that he is the applicant (Name of in~lividual signing ebove n,med. 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 ~11 ~,tC~terrLents contained in this application are true to the best of his knowledge and belief; and lhar the work will be perfc~rmed in the manner set forth in the application filed therewith. Sworn to before me this "- - 1 ! ADDiT'ioN MR. E, MRS. NAS.SA u R. HANSEN