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Home My WebLink About5344-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5344 Z Permission is hereby granted to: ............. ,T~.'~-~J, · · ~; ~ ~-~, a · ..[ae ............................ ............... )* ~3 .... ~: ~t3,e.. Cmm.t,~...~M, ........... .................. .~.~Z.4,~, ....... N.,.Z.,. .............................. to ...... J,~t I,~[.. ,~e~ .. e.~t,~.., .31t~], ~ ..,~,~e ;..;~, ~l~ .............................................................................. at premises iocoted at ............ 'J~V'¢"--'~' ....... ].~l.t~'~"-~'"~,tl~'&'y"~l~l ............................................ ................................................ D~ .3~e~,-.~- ......... L, maze~. ...... ~Z., ................................................. pursuan~ to application dated ................................ ~'~'"'-1'0' ........, 19.~.., and approved by the Building inspector. Fee $....:I.C,..Q~ ........ Bu' d' g spec~or ~ FOK~ NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No ............................. Approved ...................... ~.., ............... , 19 ........ Permit No ............................. Disapproved a/c .................................................................................... - (Building Inspector) 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, end giVing a detailed description of layout of property must be drown on the diagram which is port 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 port for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment for the issuance of a Building Permit pursuant to the Building Zone Ordinance of t.he 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 all applicable lows, ordinances, building code o~d regulations. , . ....... ........................ (Signature of applicant, or name, if a corporation) ........ (Addrdds of applicant) ' (/ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. /_ If app~[icant is c),.~rporate, k~gnatur~of duly a~)thorized/~fficer. (Name and title of corporate officer) o~.~ ~, 1. Location of land on whlch/,~ /) ~ ~pr°p°sed work will b~, done. Map N . Lot No.: .~...~...; ............. Street and Number .~.~....~....~..:'. ................ ~ ...................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: O. Ex sting use and occupancy ..... . .~.~,~-,~.~ ........ ., ......... ~ ......... .: ..................................................... · ........... .~ , .mu~e o, work [check which applicable): New Building v/ Addition Alteration Reoa~r .................. Removal .................. Demolition .................. Other Work (Describe) ....................................... 4. Estimated Cost ..... ,~.~.~..~.. ..................................... Fee .............. ~...~....~..~:'... ............................................................. (to be paid on filing this application) 5. If dwelling, 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. 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 .....~. .........Number of Stories ............................................................. ~, .................................................... 9. Size of lot: Front ....... .I..~...~. ............. Rear ......... ~.~..~.. .................. Depth ...../..~..~...~ ............. 10. Date of Purchase ......... ~,s~..'. ............................. Nome of Former Owner ..~:J~..~l~'J..~...~..~.~4~.i'&...~...~.7~.~ ...... 1 I. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ..... J~...~..:. ............................................ 13. Name of Owner of premlses~..~...~..~t~..~..~..~.~ ......... Address .....~/~...~.~...)~. ................. Phone No. ~.~.'~:.~./.~.~. Name of Architect ...................................................... Addres~i "~ ............................................ Phone No ....... ~ ......... Name of Contractor ......................... ~ ....................... Address ................. ~ ....................... Phone No ............. -'-. ....... PLOT DIAGRAM 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 description according to deed, and show street names and indicate whether interior or comer lot. STATE OF NEW YORK, ), c e COUN,~_o~_ ~'~' _~'/~ ~,OF ..~ ......................... $~'~' ...... ~-~,e'~.,-~,~,~C;~-..~... · ..........: ............................ being duly sworn, d~es and so~ t~ he is the applicant (Name of indivi~oi signing application) above named. He is the ............. ~ .......................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly outhortzed to perform or have performed the said work and to ~ke and file i ti n h II e n ' ~ I ti n this appl ca 'o , t at a stat ments co rained 'n this app Ica o, are true,to, the best of his kn~ledge and belief; and ~hat the ~ot~ ~111 J~ ~rf~(~ Iff the ~Hef ~f f~HH Iff th8 ~ll~8}l~H fllg~ fh~f~lJh: x ~worn;r~ ,~- '[p be[pre me this I t ~/' ~ ~-~ - ,///~ ...... ~, . .............. z. d.,, ..... . ......... ............. Noto~ Public, ......... I,~.~....~ ...... ,.,,,L¢~; ...... Coun~ (S,gnature of epphcant) ~d with N.Y. t~), ~lk.. A ~e~ 0fi,