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Home My WebLink About5379-z FOEM NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, bi. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby gronted to: ..... [e~..~l~....A/C...~.e~r~.. ............... $~th~t ............................ i ................. to ..... ~,~L3,~..a~..acldS. t4Le~..&..a~k~..e&ter, a~-ela$...4 ~..ex~t~ug...~'~ 9J~.:tl~ ........... at premises located at .............. ~..~/~ ........................... i ......................................................... .............................................................. ,~mat~.;L~ .......... ~"~"'i ......................................................... pursuant to application dated .................................... ~l~e,....~-..., 19.~..., and approved by the Building Inspector. £ee $....~.e.~ ........... ~" :r~tc'~"~uilding Inspector FOR~ NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT 'I~OWN CLERK'S OFFICE SOUTHOLD, N. Y. ........... Application No. " ......... Approved ........................................ , 19 ........ Pemit No. Disapproved ~ _.~ ......................................................... ~x"/~/7 ~ ~ ~ ................................ '(B ui id in~"i;;~;;;:'l;;;;i'""~~i~7 '~ APPLICATION FOR BUILDING PERMIT Date ................... ~.m~.....2E. .......... 19.71 ...... 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 all applicable laws, ordinances, building code, housing code, and regulations. lienneth ~chold (Signature of applicant, or name, if a corporation) ......... am,thcli ..................................................................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................................ i~e~t...~...e~mer. ................................................................................................................ ame af owner af premises If applicant isaco~orote, signotureofdulyouthorlzed offscer. 1. k~otion of land on which pr~osed work will be dono. ~op ~o.: ....... ~ ......................... kot ~o..~ ............... Street und ~umbe~ .......... ~..~ ...................... 8~U~&~ ......................................................................... ~J ~ / ~ ~ 5 Municipali~ 2. State existing use and ~cupancy of premises and intended use and ~cupancy o{ pr~osed construction: a. ~isiting use and ~cupancy ..... ~ ......................................................................................................... b. Intended use and occupancy ............ ~,...,~..~,.&~i.~i~ .............................. Repair .................. Removal .................. Demolition .................. Other ~o~ (~H~ ~. ....................................... 4. Estimated Cost ....... $1000...'b. .................................... Fee ........ ~,.00 .............................. ~ ........................... (to be paid on filing this application) 5. If dwelling, number of dwelling units .......... e~,.q ............ Number of dwelling units on each floor ............................ If garage, number o cars .. 6. If business, commercial or mixed occupancy, specify nature and e~xtent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ............... ~ ......... ~.. l~ear ..................... ,; ........ 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 ..... .12 .......................... Rear .1..~.. ........... Depth ... 22 .............. Height .................... Nur~ber of Stories .................. 0~ ............................................................................................. 9. Size of lot: Front ............................ Rear .................................... Depth ................................ Date of Purchase ~ [~7~. Name of Former Owner ~'~'~ 10 1 I. Zone or use district in which premises are situated .... ~.~. ~:1.~.t~ . . ~ 12. Does proposed construction violate any zoning law, ordinance or regulation? ......... .~..e.. ............................................. 13. Name of Owner.of premises ..,~e.~Z'~...~.~.~e~..S.'G.~l~cidress ........... ~..e..u....~..~..O...]:.~. . Phone No ........ Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ~.~...~.¢.~.~,.~. ............................ Address So~?,ho[el. 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 ~o~,.u~b r whether interior or comer lot. er~o description according to deed, and show street names and indicate STATE OF NLCW YORK. COUNTY o f '.el,k ............ ........................................... ~e~.l~.'G~.~g'l ~1, .................... being duly swam, deposes and says that he is the applicant (Name of individual signing app cation) above named. He is the .......................... J~g~...O~...~rL~.~' ................ ~ ................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work,6nd to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and tha~ the work will be performed in the manner set forth in the application filed therew th. Swam to before me this ~>.~;,,, ~.~. ,~ ................... ...... ....... ............ , Notor~ Publi/~[~"~'~'~.~.'l~ C~oun ~"/~'"~'n~'~'f~'~''' ............. ~ ~ ........ , t~~ (Signature of applicant) .......... /I ELIZABETH ANN NEV~[L£ ~ II/ ' f~ROTARY PUBLIC, ~te ,'~lew York Term ~pirel Mitek 30 l'~g~