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Home My WebLink About5891-z FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5891 Z Permission is hereby granted to: ........ ~.,~,~teemee~..~.e~el~ea. ................. · ~,~ ~"'l,l~l':l:~ ................................... to ~llJ.~.4..lla.. &d~el~..e~.. el~l~m~g ...... ale &il Rl~ ' 'J~IL~. ~:~ lJijl;' .................................. at premises located at .......J~.&q~e-.~--]~JJL'eae~l~"~rl, l, jgll ...................................................... pursuant to application dated ..........................JJ~.~' .......... JJ~ ....... , 19~1~..., and approved by the Building Inspector. Fee $.....~J~j,i~) ...... Bu:l~ In~r APPLICATION FOR BUILDING PERMIT ~ Date .... ~'~ .............. ............... INSTRUCTIONS a. This ~ppli~:ian must be completely filled in by ty[~writer or in ink and submitted ie triplicate to the ~uilding Ins~ctor $ sets of ~n~, ~ur*l~ Cot Plan to *cale. Fee according to schedule. b. Plot ~l~n sho~ing Io~ation of lot and of buildings on premiss, relationship to adjoining prem ~s or pub c str~'~ or aree~ giving a datliled de~ription of layout of property must be drawn on diagram which is part of this application. * d c. The wel~ co~ered by this application may not be commenced before issuance of Building Permit. d. Upon el~:)roval of this application, the Building nspector w I issue a Building Permit to the applicant. Such perm t sbe I be ke i~r the premises a~ailable for insPection throughout the work. '~ e. No building shell be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shell have granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building [om Ordinance of the Tow~ of Southold. Suffo~ County, New York, and other applicable Laws, Ordinances or Regulations, for the constructidn buildings, additions or alterations, or for removal or demolition, as bereiri described. The applicant agrees to comply with alt 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 e corporation) ....... ........ .......... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..................................................................................... ...................................................................... Name of owner of premises .................. .l~..~l~...~.~....~....l~l[l~...[..e....~ll~...~..[. .................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Locetion of lend on which proposed work will be done. Map No,: ......... , .......... Lot No .............................................. Street and Number ......... ~f~t~~*~&~[~[~~e~e~[~:~I~a~1[~ ........ ,~, 5'~- Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: e, · · Ex~stmg use and occupancy ................................................... ~ ..................................................................... Intended use and occupancy ................................................ 3. N~,tur~l~ work (check which applicable): New Building ....................... Addition .......... &.....,... Alte a o ............... Repair ..; ...................... Removal ......................... Demolition ........................ Other Work .................................... (Description) 4. Estimated Cost ........ ~.,.gO. ...................... Fee .......................... ~e~l ......................................................... (tp 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 ............................. ~...~.1~.., ............................................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ........... ~ ................... 7. Dimensions of existing structures, if any: Front ....al,~?. ......... Rear ....... ,1,~..t. ............ Depth ........... 1~..l. ................ Height ..~.....~...ll.~l~.:l~. ............................ Number of Stories .................. 3, ............................................. ; .......... Dimensions of same structure with alterations or additions: Front ......... .1,&.t. ......... Rear ................ ~1~ ................. Depth .......... ~..I. ............................ Height ..., ....... al,~t~ ......... .' ............ Number of Stories .................. 1 ................... 8. Dimensions of entire new construction: Front ......................... Rear ............ : ............... Depth ................................. Height ................................................. Number of Stories ......................................................................................... 9. Size of lot: Front ............ },0~..I. ................ Rear ............... ~.?. ................. Depth ............. ~{N~.e. ............... ~ ........... Height .................................................... Number of Stories ...................................................................................... 10. Date of Purchase ......... ..~...~ .................. Name of Former Owner ............................................................................ 11. Zone or usa district in whiCh premises are situated .................................. ~.ll~.~,ll~,&l, ......................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ............................................................ 13. Will lot be regreded ........ ~.....,~....,_..,~Will.excess fill be removed from premises: [~J Yes [ ] No 14. Name of Owner of premises .~..t"~R~.~.~..~....*~~.~.J~r...Rt.T.~.~M~;~..~M:~J~`..~q&~:£~`~ ..... (Address) (Phone No.) Name of Architect ..................................................................................................................................................... (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 wheth- er interior or corner lot. STATE OF NEW YORK, ~ __ .. ) COUNTY OF ................... ~..~..~..~ ................ I '~ SSi L a K, F_. V ~ E.~,,~ Tz R- .............. ~e........~..~.~?..?..._~.~ .~..~. ....................................... bein, duly sworn, deposes and says that he is theapplicant above named. (Name of individual signing contract) He iS the ............. ...0~...~,.~.~..~....'~. ......................................................................................................................................................................... (Contractor, agent, corporate officer, etc.} of said owner or owners, end is duly authorized to perforrn or have performed the ~aid work and to make and file this ~pplication; that ell statements con, rained in this application are true to ~8,f bb~]~)wledge and belief: and that the work will be performed in the set forth ~n the application filed therewith. N~ t~ubL[e, State o! ble~ ,._~T£P/-~A/ C,,w~ /k/A,et£ L. ,~£~ow,.~/,(t