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HomeMy WebLinkAbout5348-z romvi NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT! TOWN CLERK'S OFFIC£ ~r sOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMI$1~S UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5348 Z Permission is hereby granted to: ..... ,~ea~h.J~as~/~ ......................... i ................. ......... ~e~,~,..P4t .......................... ! ................. to ..J~a~...au..aO.a~.tien..o~..e~.~a~iua.. a~e:h%~t~O..~. ........................................................ of premises located at ....~;..~ ......... ~e.~...C~rek..,ge'e, ................................................................. .......................................... ]~/-~....ama..~ .............. Seu.~ ......................................................... pursuan¢ to application dated ............................ ~O.~ ....... ~.....:....., 19..~.[., and approved by the Building Inspector. Building nspector ~/~/7~ ~,,~ TOWN OF SOUT~OLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE  ~UTHOLD, N. Y. Examined ........ ~.~ .......... , t9~[.. ~ ~ ~/~ Application No . ~.~Z.; ...~ rovod .................................... .... Disopprovod o/c ..............~ ................................................~ ................................................ ..... ............ !.! ................ . .... INSTRUCTIONS a. This application must be completely fill~ in by ~pewriter or in ink and submitted in duplic~e 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 detail~ description of layout ofproper~ must be drown on the diagram which is ~ of this applicati~. c. The work covered by this application may not be comme~ed before issuance of Building Permit. d. Upon approval of this application, ~e Building Ins~tor will issue a Building Permit to the ~plicant. Such permit shall be kept on the premises available for inspection throughout the pr~mss of the work. e. No building shall be ~cupiod or u~d in whole or in pa~ for any pu~ose whoever until a Ce~ificate of ~cupancy 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 all applicable laws, ordinances, building code, housing code, and regulations. // (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .....~....~ ........................................................................................ ..~ If applicant is a corporate, signature~' 'of duly authorized officer. ~,~ i~' ~' I .tx 1. Location of land on which proposed work will be done. Map No.: ~ ..~...~ Lot No....../~.. .............. Street and Number ............ , ........ S.Q~--l'tn]-rl,...~[*-~r ........... ~..~ ...................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ......... O~e...:~ala~..].~...~ie.].].J4~cj'. ......................................................................... b. Intended use and occupancy ......... ~ntn~ ..wS.e.~..arlc~.t:~cm. ............................................................................ 3. Nature of work (check which applicable): New ~Building i. ................. Addition ...X~C ....... Alteration................,. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ...: .................................... 4. Estimated Cost ..... $2,,D. QD, .+.-. .................... Fee ............. ,~5..0D. ....................................................... (to be paid on filing this application) §. If dwelling, number of dwelling units .......... 1 ............... 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~!xistina structures f anv' Front .~..~. ~ ... R~- ' :2- C/' r~,+~ ' Height ....................Number of Stories ................................................................................ Dimensions of .same structure with alterations or additions: Front ..... ..~....~.. .................... Rear ...... ..~....~. ........... Depth .~..~c~ .................... Height ....~. ..................... Number of Stories ................................ 8. Dimensions of entire new construct on' Front ~ r~, Rear ...~...~. -- ~-. ........ · ~ ............................................. Oepth ............. ,~ ........ Height ......c] ............ Number of Stories ...................................................................................................................... 9. Size of lot: Front ....... .~...~. ........... Rear ...... ~...~ ..................... Depth ...... ./....~. C~...__..._..._ ............. ,-, , ........................................................ Name of Former Owner ~1~:%~....~ ................ 10. Date of Purchase 11. Zone or use district in which premises ore situated ....... /~F- ........................................................................................ (/ 12. Does proposed construct on violate,~ . .'_,~any zon ng aw ord nonce or regulation? ...... ~ ........................................... 13. Name of Owner of premises .~.~A~...'..~..~ress ~..'~.:~....~--,~...~.....'~ Phone No ....... L/ Name of Architect ...................................................... Address-Q~.~.-=~...~.~....~'~'/,~'X' ........ 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 corner lot. STATE OF NEW YORK. ' ~ ¢ ~ COUNTY OF ..... Suffolk .......... .~,ttd~.~W ....... ~.3~;L].~ ........ ~...;.......'~ ..................... being/duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the .......................... c~:Je~t ............ ;~ ..................................................................................................... (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 thor the work will be performed in the manner set forth in the appllcatio~ filed therewith. Swam to before me this ........... ll.th...,,,~/'~_ /~A ~/~ 'dav of ............. ~LLO.~ ...... ~ ............. , 19...7.~,. Nato Public,~" -/,~s~ / /'~'~ '// /'*'' ~'' '" ~~'":'~'"~"~'"~ ........... ry ~.-~ ..,~,~,~~ ....... ~oun~' or' ~Ummolk (S6~l'nature of applicant) ...................... -- ~LI~AB£TN ANN NEVILLE NOTARY PUBLIC, ~ate of New York No. 52-8~2585B, Suffo k CouAty Term Expires M~¢h ,30.