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Home My WebLink About5946-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) N? 59~6 Z Permission is hereby granted to: ~,a,~...c~....~l....~,..l~!as .......... at premises located at ....... ~t~...l-I ....... i.~eJ..~l.~.ll.....~.~....'.~ ............................................... .................................................. l~t~h..l~e~d ............. ~l~t *~:~ir~k ..i.# ,~., ...................................... pursuant to application dated ........................~T. t1~.8......~ ........ !,..., 19...~, and approved by the Building Inspector. Fee $'"1'~;~ ......... FOEM NO. 1 TOWN TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No..,.,~,,.~,,,c,,/,,~. ................ Disapproved a/c ............................................................................................ ........................... ................................ APPLICATION FOR BUILDING PERMIT Date J~,.r).~ I h- %? Lh ................................................. 19...~ ....... INSTRUCTIONS ; ~ a. This apphcat~on must be completely filled in by typewriter or in ~nk and ~ubmitted in triplicate to the Building Inspector, wit 3 sets of plans, accurate plot plan to scale, Fee according to schedule. 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 of property must be drawn on diagram which is p~rt of this application, c. The work covered by th~s application may not be commenced before issuance of Building Permit. ~ d. Upon approval of this application, the Building Inspector will ~ssue a Building 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 w6atever until a Certificate of Occupancy shall have bee~ granted by the Building Inspector. APPLICATION IS HERESY MADE to the Building Department for the issuanc~ of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applmable 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, budding code, housing code, and regulations, and to admit authorized mspect0rs on premises and in buildings for necessary inspections. M.S.T. Construction Corp (Signature of applicant, or name, If a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~O:Clb_ 61,0 bO~ Name of owner of premises .................. ~'J~,...~:Ja.~;k~;~.s .......................... If applicant is a corporate, signature of duly authorized officer. 1. Location of land on which proposed work will be done. Map No.: ....... ~.~.~.~.t...~.a,,:La.....z~ ..... Lot No ............. Municipality 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 ~' ~ w, ..... N 10, 11. 12. 13, 14. Nature of work (check which applicable): New Building ....................... Addition ......... ~..~. ....... Al ~eration....; .......... Repair ......................... Removal ......................... Demolition ........................ Other Work ........................ ........... 1 ~ Description) Estimated Cost .......... ~..~...-~.. .................... Fee ........... ~. ~ .~.~) ................................................ (to be paid on filing this application) ~ If dwelling, number of dwelling units .D~ ......... Number of dwelling units on each floor ..................................... If garage, number of cars ........................................................................................................................................... If business, commercial or mixed occupancy, specify nature and extent of each type of use .......................... ~ .......... 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 ....................................... [)imensions of entire new construction: Front .,?~. ...................Rear .......... ~.2 .............. Depth .......~.~ .................... Height ................................................. Number of Stories ....c~e ............................................................................. Size of lot: Front ...................................... Rear .......................................... Depth ................................................. Date of Purchase ..................................... Name of Former Owner .......... )~...o...~..~ ....................................... Zone or use district in which premises are situated .n..~..~ .~!.~.~.~ ............................... Does proposed construction violate any zoning law, ordinance or regulation: ............... no ........................................ Will lot be regraded ....... ~ ....................... Will excess fill be removed from premises: [ ] Yes [ ] No= Name of Owner of premises ..... ~'h~....~{~.~, ........................................................................................... . ............ (Address) (P ~one No.) Name of Architect ..................................................................................................................................................... ~ ~ (Address) (Plone No.) , Name of Contractor l~.~v '- o~.. C,~.~.~.~.~ ~ .......................... ~.3.~.~3~'~ ' ~ ..................................................................... Address hone No.) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-b :k dimensions from property lines. Give street and block number or description according to deed, and show street names er interior or corner lot. F(7~O ~[q-- ~(/~. ~ STATE OF NEW YO~.l~r O~.k COUNTY OF ...................................................... .................................................... [~.,....~(~.~4~,% .......................... being dulv sworn, deposes and says that he is the (Name of individual ~igning contract) hie is tbe ................................................................. ~ ........t~ ...~ ..................................................................................... 0~ ~'o~j)~¥t~, agent, corporate officer, etc.) of said owner or owners, and is,duly a~Si~Hz~d~t~l~rform or have performed the said work and to make and file statemants contained in this applicator. ~rb~ctrt~o*f~s~e~f his knowledge and belief; and that the work wdl be 'cJ'J44963 SUffolk Coun set forth in the application filed~he~e~l~.~ ~, ~ .......................... ..~,'. ........ day of ........................ ~...,L~..~ .............. 19 ...,%~. .... ~ __ ~ Notary Public, ounty ....... ,. ~/ ' (Signature of applica~ md indicate wheth- ~pplicant above named. this application; that al! ,erformed in the manneI