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Home My WebLink About5932-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne 5932 Z Permission is hereby granted to: at premises located at ............... ~. ......... ~)(~,)~j.~,.y.....~C,,~..,t.T ............................... ................................................................................ /~.~.~-.~-~ ................................................ ............................................ , ................................................................... t~..~..~.1. ............................ pursuant to application dated ............................... 7...~/,.i~/~,~.., 19.~. ,~nd approved by the Building Inspector. FOI~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT~ TOWN CLERK'S OFFICE~ SOUTHOLD, N. Y. Approved ............. ....~..?~...~'...'..'~......., 19 ........ P m' ,'-lo ........................... i ........ Disapproved a/c .................... '"'" '~'"'"':'"'"'"'"~"~ -"-'--'"Zi..,..~_~.-- ................................. ........................................................... (Building Inspector) APPLICATION FOR--BUtL"D3J~'~ PERMIT Date ............. Z~ .......... , INSTRUCTIONS Application N o~......~.....~....~ ........... a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector, b. Plot plan showin9 location of Jot and of buildings on premises, relotio;nship to adjoining premises or public streets or areas, and giving a detailed description of layout ofproperty must be drawn O~n 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 o Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the progr, 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. 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 (or removal or demolition, os herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. ........... .................. (S'i'~'~a~_e~'f applicc;nt, (~r"~'~'~i"if'a c~¥~'o'rationi State whether applicant is owner, lessee, agent, architect, engineer, generol contractor, electrician, plumber or builder. Name of owner of premises .......... .;ij~..~.,~....~.....~,...G$~t.~t..~.~¥;~.~;g~.~ ........ .......................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ....~ ................................... Lot No ......................... Street and Number ......... Gg~..~?,~.~..~¢~;,~..f~.~.~'.'~..~'J~..';f~..~,~ ................. ; ....................................................... Municipality 2. State existing use and occupancy of premises and in.~ended use and occupancy of proposed construction: a. Exisiting use and occupancy ........ ~).~fl~(1.~)~oo ............................ r ......................................................................... b. Intended use ~nd occupancy ...................................................... ~ ......................................................................... 10. 11. 12. 13. Name of Architect ...................................................... Address ..................................... ,. ...... Phor Name of Contractor ........................ ......... : ................. Addr, ess :7,..:.7. Phor Nature of work (check which applicable): New Building .................. Addition .................. AIt,'ration .................. Repair .................. Removal .................. Demolition .......... '~¢r'.. Other Work (Describe) ......... Estimated Cost ............................................................ Fee ..,.~./.....Z'...~...'...~ ................................ (to be paid on filing this apFlication) If dwelling, number of dwelling units ............................ Number of dwelling units on each floc ............................ If garage, number of cars ......................................................................................................................... : ................. If business, commercial or mixed occupancy, specify nature and extent of each type of us, t ............................ Dimensions of existing structures, if any: Front ............................ Rear ................................ De Height ........................ Number of Stories .................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rea~ ............... : ............. Depth ................................ Height ............................ Number of Stories ................................ Dimensions of entire new construction: Front ................................. ~.. Rear ............................ De )th .......... 4 ............. Height .................... Number of Stories ...................................................................................................... ~ ............. Size of lot: Front ....... ./....O..?.. ......... Rear ......... (.,,.u.,,.~. ................. Depth ............ /...,~..,'/)'"" Date of Purchase ........................... ,~,-- ,,. -- ./.z~.~...~..../~-.....:~........Name of For~ner Owner'1'2' ~'" /~ -- .~..."...,.,~.~'¢?~1~/).,~/.~ Zone or use district in which premises are situated .............. ..~..~.~..?...~.. ......................................................... i ............. Does proposed construction violate any zoning law, ordinance or regulation? ........................................................... Name of Owner of premises . .~.....(~.~....~.~.....~....~....~..i./..~...~..~ress,-__ z . ~. ____,~,~,~m ............ ' '- -' ' ---- .~....~...Y...Y......,?.....~.. ..... Phor~"~'~o.~....-: Locate cleorly~and distinctly all buildings, whether existing or proposed, and indicate all set~ba~ property lines. Giv~ street and block number or description according to deed, and show street whether interioror comer' lot. dimensi6ns from ames and l indicate STATE OF NEW YORK.. - ~-- COUNTY OF .............. ~.~...F'.-..P.~...~.j ~.5 ................. · ~....../~...J..~..~.~J:.~... ............................................ bain duly sworn, deposes and says that (Name of nd v duals gn ng ,gPP c~jon), above named. He ~s the ....................... ...... ~.~ ......................................................................... (Contractor, agent, corporate of of said owner or owners, and is duly authorized to perform or have performed the said work and this application; that all statements contained in this application are true to the best of his knowle that the work will be performed in the manner set forth in the application filed therewith. Sworn to be:E:~e_/me this --J' f/' A,/~~- '7 % ' · ,./(... day of , 19' ............................................................ Notary Public,. ....................................................... he is the ~pplicant :icer, etc.) ~ to make land file tge end beJlief; and