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Home My WebLink About5328-z FOEI~/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) N? 5328 Z Permission is hereby granted to: ............. ,~, ..~.e..~.e,...~A~ ,o.~e. ~ ............. ~ .................. .................. .~.&~ ...... .~,~,~..~ ......................... ......... /~ewt,~t~l .................................................... to .... ,~Lel..~:~..~..~J.~...~e~,:Z~ ................................................................................ at premises located at .......... ,~/~......~.~..~...~.~...?.~..~...~- ....... ,(-~,-~..~..~.). ....... .]~..~,.----J~.~-~.~...~ ....... ............................................ ~t~ ......... ~.~'~, .............................................................................. pursuam to application dated .............................. ~'~.'l......~J(~.i ...... , 19..~.J.., and approved by the Building Inspector. Fee $..~ .......... X I~OBaf ' NO. I TOWN OF soUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. APPLICATION FOR BUILDING PERMI'r ~ Date .......... ~...~.../~...4.~ ...... Z~....~ ......... . 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_C~ areas, and giving a detailed Cl~scription 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-eemmenced 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/~Ti~DE 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 I-aws, 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 all ,applicable laws, ordinances, building code, housing code, and regulations. ·. (Signature cf applicant, or name, if a ~orl:~oratJon) ....... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ....x~.~../~..~..~.~i.....,~..i:'...]i~.~'~.~.i.i..~/~.... ............................................... i ......... If applicant is a corporot~e, signature of d~ly authorized officer. ~ (Name and title'of corporate officer) T~ -~ ~ D 1. Location of land on v~hich proposed work will be done. Map No.: ........................................ lot No.: ...................... Street and Number I.~..~:~.?.~.~......~...~....~...~......?..~.~....H..~.~..../.?.~.~. ..... ~..~.~ ~,_ ~ .,...~,...~...C. ~ 14~ · ~-~00- ""/~/"~-~?~,r'9" ,~d if.~-~/ Municipality ....................... 2. State existtng use a.nd occupancy of premises an t~'d~ntended use and occupancy of proposed construction: a. Existing use and occupancy ...~..~......~... ......................... b. Intended use and occupant,' ...../...~..~.~.~j'~..~....~,,~.. ............... . Repair .................. RemoYal .................. Demolition .................. Other Work ([~scribe) ........................................ 4. Estimated C-~st ..... ..'~.....~.....~....~...~..;...~ ........................ Fee (to be paid on fi!lng this application) 5. If dwelling, number of dwelling units ....... ./,. .................. Number of dwelling units on each floor ............................ If garage, number of cars / 6. If bus ness, 'commercia| ~r mixed occL Dancv snec fy nature end extent of ea~- *- .... ~ 7. Dimensions of e~tin s~tructures, if any: Front ......... ~ ............... Rear .......... ~ .................. Depth .... ..~ ............. Height ......... -'S .............. Number of Stories ........ -'T ........................................................................................................ Dimensions of same structure with alterations or additions: Front ............. -~. ...................... Rear -- Depth -- Height ........ ~ ................ Number of Stories ..... ~ ....................... 8. Dimensions of entire new construction: Front ....~....'~...~..~.:..~. .............. Rear ...,.~'..~_..../..~.e'...~,..~...... Depth ....~....~..../..~.~.~...~../.'~ Heighto~...~...x~..¢.E:..7'.... Number of Stories ......~... ....................... ; ........................................................................ 9. Size of lot: Front ..... ,,/,,,~..~.....~.¢..~....'~.. Rear ........ /..~...~.....~....~..~..~.~.. Depth ...~...~...~......~-~...~....~c.,,f.~.. 10. Dote of Purchase .....~../...~.?'../.~.,~...~;~ .......................... Nome of Former Owner ..~..~....'~..~_..,~..,~,..~..C'~......'~..Z.~..E...~_.~,~ 11. Zone or use district in which premises are situated .~...4~...,~...-d.~..~./~. ................................... 12. Does proposed construction violate any zoning law, ordinance or regulation;> l~' e 13. Nome of Owner of premises ,.~...~'.~,..,,~,.,~,...,~,:.~..~./..'/_.~,,Address ,,,~,...~..¥.,,~,,~.~..-...~,e,..~..~,~..~.... Phone No · o'~ ,,~ //,~,o~'~/ ~e~e/- .................... Name of Arch.tect ~.e.~..~....~....~......~...e'....~..~..~.~.Z..Address ...... ..~/.E~.,T-,',',',',',',','~_...e..~..,~'.. ......... Phone No. ~..~ .~...-:....~.../..d./9 Nome of Contractor .................................................... Address ............................................ Phone No ..................... PLOT DIAG.C~M Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block, number or descrJptio,n accordin~ to deed~ qnd show~ street names and indicai'e whether interior or corner Jot. - - ~ T I. 15o' STATE OF NE~C~I~I(~, IS.$ COUNTY [~.~.~ ........ ~J' ' ...................(Na~e~n~?~al~~ .................. (~- ~.being sworn, opplic~%._._ .. duly deposes and says that he is the opplicont signing 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 oil statements contained in this application ore true to the best of his knowledge and belief; and that the work will be performed in the manne~ set forth in the application filed therewith. Swam to before me this ,-~ ......... ....... Notoe/Public,~~ ....... C~un'''''''~''''' '~''~'''''~''''''~''Zty ~ (Signature of applicant, .............................. NOTARY PUBLIC. State o~ New York No. 52-8125850, Suffolk CouJtJlL Term Expires March 30, 19~.~