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Home My WebLink About5916-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, bi,. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE Pt~,EMISE~ UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5916 Z Permission is hereby granted to: ..... ~...~:.~.~.~...',~.e.~.~.e.....;,..,~..~.~.~......-....~0 .. at premises located at-...l~,/{~-.~, ktl~e,l{4{~ ...... ~-,~~ ........................................ .......................................... ~ea.t,h~t~i .......... ~,,~,, ................ ~ ............................. ; ........ ,..~ .................... pursuant to application dated ......................~:111~1.:..~ ................. ~ 1'9...~t~; o~d approved by the Building Inspector. I' ~" ' ~,Bbllding In~ector ( FOItM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMEN'~ TO~VN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 19 ........ Pemit No ............. ' .............. ~ ......... Application No. ~ ~F [.~ APPLICATION FOR BUILDING PERMIT ~,Dote ...... ~.../. ....................... , 19..~... ,.~'?~-- INSTRUCTIONS e. This application must be completely filled in by typewriter or in ink end !ubmi'Ltad in triplicate to the Building inspector, with 3 sets of plans, accurate plot plan to seele. Fee according to schedule. b. Pict plan showing location of lot and of buildings on premises, relationshil~ ~o adjoining premises or public streets or 8tees, 8nd giving ~ detmled description of 18your of property must be drawn on diagram which is pert of this application. ~. The work covered by this npplic~tion may not be commenced before issuance ~f Building Permit. d. Upon ~pprov~J of this ~ppHcation, the 5uiiding inspector will issue a BuiJdin~ Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose w~atever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION tS HEREBY MADE to the Building Department for the issuanc~ of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, SuffoJff 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. ~he applican~ agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. ~ (Signature of applicant, or name, if a corporation) .............................................; (Address of ~Hcant} State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ¢j ............................................................... ......................................................................... If applicantli~ a corporate, signature of duly authorized officer. .................................... (Name and title of corporate officer) 1. Location of and on which proposed work will be done. Map No.: . ....' ........... Lot No ............................................. ~ Street and Number .,(..~.~. !.~.~ .....L~ .~,,,4 . . ~01~ . ~'~1~6 0 ................ ...................... .......... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................................................................................................................................... b. Intended use and occupancy .......................................................... ~ ....................................................................... 3. Nature of work (check which applicable): ......... -~ ' ' '"~'~ · .............. New Budding ....................... Add~t~prt ...i~. ~"' ......................... Re~5~''~". ........................ m,,~J Other Work ...! al De i~i15~'. ....................... 4. Esti mated 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 .....................B~ear~.. ......................... Depth ...... Height ........................................................... Numbe~es ................................................ Dimensions of same structure with alterations or a~ions:--~'/ ~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 ...................................... Rear .......................................... Depth .................. 't"l'u yhL;; ........................ .-;7;'......,~ ............... N~.....,~. '.,..-,,-'~,,=, ....................................................... 111~ Date of Purchase~..~...~..~ ............... Name of Former Owner ..?~..,..~.~'~.~.¢...~.I~.1~.... 11. Zone or use district in which premises are situated .................... '.'~5~.. .......................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ....~. ............... 13. Will lot be regraded .................................. Will excess fill be removed from premises: [ ] Yes 14. Name of Owner of premises~'~..~....~....i~..e.~..~.~,.....~.~.~:-- -- -- ...... J~..~.!~...~...~.;..,.~;.~.~.~.~.~..;.'' ' Name of Architect ...................................................................................................................... (Address) Name of Contractor ................... : ............................................................................................... (Address) , PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-b. property lines. Give street and block number or description according to deed, and show street name., d~ra"{ion ............... ............. (Description) []NO ...... Phone No.) Phone No.) Phone No.) i ~ck dimensions from and indicate wheth- er interior or corner lot. ~ ~,,~ { ~f;~t. St~.~.~ STATE OF NEW~OR~ ¢ ~ t~ ) COUNTY OF .....~..~.~..~.......) ...}~..~....~ ............ [.~.~r ..................... beina d~lv sworn, de~osos and ~aVs that ho [N~[ individual ~g contractJ ......................................................................................................................................................................................... [Contractor, agent, corporate officer, etc.] of said owner or owners, and is dulg authorized to ~orform or halo ~erformed tho said work and to make and statoments contained in this aBplication aro truo to the bastJ~ ~n~e and bo~ief; and that tho ~ork wi~ bo *~rformod ih tho marmot set forth in tho aOplication filod tharowith. ~o~or~ ~ublic~ 5~o~o o~ ~ow York ~ 2 ~ No, 52~0344963 Suffolk Count~ ~ ( / z ....................... /.....~...day~,~ ~°f' ...,: ........... ~ ................... Count 19/~..;~~_~ ~:~~~~ ~/']..L ........... ~ , i~tgnatur~pnca