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Home My WebLink About5421-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. N°. (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 5421. Z D~te ............ '. ....... ~I~L~.....~, ................ , 19..~.J.. Permission is hereby granted to: ................. ~.~.~.~ ,..-~.o...~:,~.' .:~S~,.-....~ ................. ............... ~'~t'"~'~j~ ....................................... to ...~.~.. ~e.~.. ~ ¢:~ ~ ~'" '('s~ce ~ ~;~ ')" ~.3:~t~t~jj 'i ......................................................... at premises located at .............. ~,;~S..,~. ........................... ; ......................................................... ......................................................... · ~;~" ~'~3~ .................. ' ......................................................... pursuon¢ to application doted ............................. ~J't3'~/' ......... ~' ...... , 19...~/~J., and approved by the Building Inspector. Fee 19.7J. Examined Ap~rave~ '. ....................... ~ .... , '19 ........ Permit No ........................ Disappn:wed a/c .............................................................................................. ..................... iBulldlng InspeCtor)' '"--'m'wZ' ~l~ .... APPLICATION FOR BUILDING PERMIT (~1~~ Date ........................................................ , 19 ........ INSTRUCTIONS o. 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 premMs or public streets or areas, and giving a de,ailed description of layout of property must be drawn on the diagram whlch Is part of thle application. c. The work covered by this application may not be commenced before issuQnce 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 Department for the issuance of a Building .P. ermlt pumuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New Y. ork, and other .appllcoole Lawl, .OKII .nanc.e? or Regulations, for the construction of buildings, additions or alterations, or tar removal or aemolltion, al her?n aNcr.oea. The applicant agrees to comply with all applicable laws, ordinances, building cede, housing code, and regulations. ~O~c~-~I (Signature cf applicant, or name, tf a corporation) ~ (Address of applicant) State whethera~licont i~ner~l~e~,agent, architect, engln.r, general cont~tor, el~trlclan, plum~r or ~uil~r . If applicant Is a co,rate, signature of duly authorized officer. (Na~ and title'of corporate officer) 2. State existing u~ and ~cu~ncy of pmmi~ and intended use and ~cupancy of p~ c~tm~l~: 3. Nature of work (check which applicable): New Building ~ ....... Addition .................. Alteration ~ ~ Repair .................. Removal .................. Demolition .................. Other Work (Describe) ...... ; ............................... 4. Estimated Cost ..... .1:~.Q.~..~!; ..................... ~ .................. Fee ....~.......0..0.. ....................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ..... .~.O.~..e. ............. 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 ...... ..~..9.~.~.~.~.~3L~' 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 .~ ........... 8......:...r:.~ D~pth .......... 1_~ ......... Height .................... Number of Stories ............................................................................... ~ ..................................... 9. Size of lot: Front ............................ Rear .................................... Depth ...... ~ ........................ ]0. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..!!,~,.~!...(:],.~L~ ..................................................................... 12. Does proposed Construction violate any zoning law, ordinance or regu arian? ....~.?. ............. : ................................ 13. Name of Owner of premises .~.~.S.?.....~..'.....~..~..]:~..~..S.~;~,Address ...~{~..~.~1~Q31r .............. Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor same .................................................... 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. YQB. K. I. COUNTY OF ..... ..~...~....e. ................. ~ · ........................................... ]d'~3.~&lL.3~t,O~'&[e .......... being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the .......................................... .A~a~;...e~...e~?. .................. '~....., .................................................. (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 that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ' ................ · ..~.....~lay of .............. ,~s...~.~3~., ........... , ]9.....2.1 ..... Notary Pubti~~,;(~l~.fl[911.,Cff.~t~ounty ~ (~lgnature ~-~;tT"~ ......... ~' ---~';";""~'NOTAI~ ru.~,,,, State ~f New ¥of No. 52.8t25850; Suffolk CouB~a Term ~l~ires ~; ,1~. t~0,