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Home My WebLink About5861-z ~OBM NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5861 Z Permission is hereby granted to: at premises located at ................................ ~9./.~.4V..~.'v.~/.Ar..~..~ ........... '~'~'~/":"Z~ ................... ................................................................................... · ~'~.~'.~.~.~:..z~.~; ....... .,,v:..~.: ................... pursuant to application dated .................................. )/.~...~.~...,/,., 19~1~, and approved by the Building Inspector. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, Y. Examined //r /.)~,, ..................................... i.., 19 ........ Approved .................... ../.;/......./Z~d."~ 19.../...~-. Remit No. Disapproved a/c ............... ,.~ ....................................................................... [au.amg ~nspector/ Date. . 'J/ /f//) INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, wit~ 3 sets of plans, accurate plot plan to scale. Fee according to schedule. · b. Pict 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 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 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 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 Zonq~ · Ordinance of the Town of Southold, Suffo[b County, New York, and other applicable Laws, Ordinances or Regulations, for the construction o~l buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws,~ ordinances, building code, housing code, and ragulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. / (Signature of appliCant, or name, if a corporation) /z ......................... (Address of applicant) State whether applicant is owner, lessee, agent, amhitact, engineer, general contractor, electrician, plumber or builder. Name of owner of premises - ' ~ ' - ~ 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 ................................................. ~ ....... ~ .............. -~. ............................................................................ ~,~Z 0 0 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 ............. ~;. ................................................................................................................ ..~ 3. Nature of work {check which applicable): New Building ....................... Addition ..................... Alteration ......... :..%, Repair ............. · ............ Removal ......................... Demolition .... ............. ... .... Other Work ........ ................ . ........... (Description) 4. Estimated Cost ...........~*,/..~..,/.~..2....~_. ............ - //~' tee ....... ..x ...................................................................................... (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 ..... :.~.,,~ ....... Rear ........ ~.,..?.. .......... Depth ................................... He'ght .............. ,/,~,! ........................................ Number of Stories Dimensions of same structure with alterations or additions: Front .......................... Rear ........ ; ...... ; ......................... Depth ................ ~..,...., .,~..-..;,..w..'.... Height ............... .~..~- ................. Number of Storms ........................................ 8. Dimensions of entire new construction: Front ......................... Rear ............................ Depth ................................. Height .......................................... , ...... Number of Stories ........................................................................................ /If' 9. Size of'lot: "/' Front ................ ~,.6 ............... Rear ................... ,.-. .................... Depth .................................................. Height .................................................... Number of Stories ~ ........ ~ ............................................................................ Date of Purchase ~' ' "~ / ~ ' ........... , ........................ Name of Former Owner ............................................................................ Zone or use district in which premises are situated .................................... :.T. ....... ~. .................................................... Does proposed construction violate any zoning law, ordinance or regulation: ....................................~ ............. Will lot be regraded .............................. Will excess fill be removed from premix.se?: [ ] Yes [ _ ] No Name of Owner of premises ,.,J,,,.~..,.,~.) ........ : ............. ,..,..,.= .................................................................................... (Address) (Phone No,) Name of Architect ..... .;.,;2,,.',;,,2,,,,~- ................... ,;,.,;',,,/3,,,& ........................................................................................ --"-'-' (Address) (Phone No.) Name of Contractor ........................ ~,~,. .................................................................................................................... (Address) (Phone No.) 10. 11. 12. 13. 14. 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 wheth- er interior or corner lot. STATE OF NEW YORK, ) COUNTY ~ ' ~ ~ ~ ~ OF ............................ ,~..~ .............. ;...~ S5' ..................... ,-% ........ , ............ ;....{....~......&.~...,,w. ............................ being duly sworn, deposes and says that he is the applicant above named. (Nam~ o/individual signing contract) He is the .................................. /..~ .......... i...i&.... ...................................................................................................................................... : .............. ~ (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 end file this application; that all statements contained in this application are true to the ~e.st of L~}TI~nTo~ and belief; and that the work will be performed in the manner set forth in the application filed therewith, ternary Public, State of New York Ne, ~2-0344963 Suffolk Counfj~. , Notary Pu bi ic,/, .,..,~;., ./;~/..........::~....~:~. ~; .~.$..~.. ~..l~u,~ u n ty ..... ;......x ..................... .~?..~ ................................. ,.-,.,'~p (2{r LA{'{O (~ ~ L~v~AN \,~-'r E.~ .,~T q"C'.,',,t4 OF %OU'r{%CLE),