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Home My WebLink About5386-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PER~iT (THIS PERMIT MUST BE KEPT' ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 5386 Z Permission is hereby granted to: ........... It.i~:e~ ..Zee~t,. J~.~i~.. Zzm ............... ............. · ~aoh..& ..llal~Je~t ..&~ ............... to ........ J~tt~i..~e~..atat~...i~.~d~r~ .................................................................................. at premises located at ........JJe~i~Jl,..&..J~lJe~..&l~ ................................................................. .......................................................... G~'~ee~p®~,t~ .......... !I~.~ ............................................................. pursuan¢ to application dated ................................ ~.~1~. ....... ~. ........ , 19..~.~J.., and approved by the Building Inspector. Fee StJ~,Oi~ ............ I- Building Inspector ? _& FOi~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMEN~ TOWN CLERK'S OFFICE SOUTHOLD, N. Yo ' '¢"/'"' Examined ....... ~ ..... ~ ........... Approved ........................................ , 19./{. .... Pemit No ..................................... Disapproved a/c ............ ~~ (Building Inspector) / :: ~ APPLICATION FOR BUILDING PERMIT Application No. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ir~k and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relatiaJpship to adjoining premises or public streets or areas, and giving a detailed description of layout ofproperty must be drawn 6n the diagram which is part of this application. c. The work covered by this application may not be commenced befor4 issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue ~ Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the progC, ess 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. i 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, buildiC~g code, housing code, and regulations. (Signatur~ of applicant, or name, if o corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, generdl contractor, electrician, plumber or builder. Name of owner of premises ...P.&e~e..~acht..~aa~..II~ .......................................................... If applicon is a corpo , signature of uly authorized ' (Name' and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ..~' ................................ Lot No.2~*~;~: .................. Mudicipality 2. State existing use and occupancy of premises and intended use and'occupancy of proposed construction: o. Exisiting use and occupancy t;~l&.t,..~'~ ................................. '. ......................................................................... 3. Nature of work (check which applicable): New Building .i1~1~ ......... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ....2.~.fO00..*.~ .................................. Fee ...%O,~to..l~.~..~i~..~n filing this apphcatlon) 5. If dwelling, number of dwelling units ...... ~III ............ 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 .~llltl~llt ........ 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 .......... ~0 ............. Depth ....... "~2Q .......... Height ...~....~. ..... Number of Stories ...................................................................................................................... g. Size of lot: Front ......... If~,~' ........... Rear .................................... Depth ......... ~8~ ................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ......... #~lt,,,~,~,,lll~ ......................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ........... ~It. ........................................... 13. Name of Owner of premises .~.:~.l~..¥_~..,~&ll~clr'l;~ ......... ~'~e~pl~zt, ............ Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ........... ~ ............................... Address ............................................ Phone No ..................... PLOT DIAGRAM I.ocate 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 nome~ and indicete whether interior or corner lot. STATE OF NEW YORK, I S S COUNTY OF ........... ~.t4;~,~;....,f ' .................. ;~ .......... ~[e~P~J";'P~L~t:P~ ......... . ........... ~ ................. being duly sworn, deposes and says that he is the applicant u'~ome at ma~aua~ s~gmng appdcatiom above named. He is the ..................O~tl.e:p..:z...~,t;~ll,.~. ..................................................................................................... (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 conta:ined 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 theres~th. Sworn to before me this .................... of ........... I),,, Tff,. ...... .................. Notary Publid-~,]~.---~ ,~,gz.~.;~.~ County ~,~f~" / (Signature of applicant) L.~TAR¥ PUBLIC, Slate of New York No. 52-8125550, Suffolk Co t T~rrn ~xpires ~arch 30,