The URL can be used to link to this page

Home My WebLink About5984-z · OP~ 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? 5984 Z Permission is hereby granted to: ~n Fork Fence ....... ~t,...3 ?.. ~.. ~ mm,~,.~.ve. ............... ................ .......... 1La.~.~ttel~ .......... : ..................... ................ to .. ~ tee ~v" a~d'"ma'~'nCaJm"~" ~o~-rt" ~:r: '~a~L*$'"fe~e a- ........... ; ....... ~ 'i' ..................................... at premises located at .......... . pursuont to opp,co.o, dated ..................... Building Inspector. Fee $.'L ~'.,r96 ........... FOEM NO. 1 TOWN OF SOi~T~-I~L.D ~ BUILDING DEPA RTML~'N'I TOWN GLERK~'s OFFIGE SOUTHOLD, N. Y. Approved ~'"/' ~ ' ~) '¢/¢~ Lt ,:~ ........................................ , 19 ....... .~,Pemit No ...... ~..~....~,.....~... ~.. ..... Disapproved a/c '' : ........................ :Z..:i. ........................ ' (l~uilding Inspector)I !i' ' Application No ....... ~.~..b..?;...~. ......... L APPLICATION FOR BUILDING PERMIT ......... pa ...... .~ ................................... ,19 ............ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and ~Hbmitted in triplicate to the BuiMing Inspector, ~ith 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, relationshi~ to adioinin§ premises or pubhe streets or ~reas, and giving a detailed description of I~¥out of property must be drawn on diagram which is part o~ this apphcation. 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 Buildin~j Permit to the applicant. Such permit ¢iall be kept on the premises ~vailable for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose wl~tever until ~ Certificete of Occupancy shall here been gr~nted bv the Building Inspector, APPLICATION IS HEREBY IVIADE to the Budding Department for the issu~ncb of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable iLaws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. ~rhe applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspect&rs on premises and in buildings for necessary inspections. ....... ~b.£"....: ........... ~.:.,,....:.:. ........ ::.~ ............ ~...'~Z ............. / ~"~)R ..~_'~ ~,.~.~gnature of applicant, or name, ifa corporation) ' ' ~ ' (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contracto~electrician, plumber or builder. Name of owner of premises , '~s ~ ~- k ¢¢ ~,,~ / 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.: ...~..~ ............ Lo~ No .............................................. Street and Number ....,-, ................ .~X~.,..¢...~,...L~,I ........ .~.c;~.,,,, ............. ~ .................................................................. ' ~ Municipality 2. State existing use and occupancy of premises and ~tend~d use an~ occupancy of proposed construction: a. Ex~st~n~ use and occupanov ........... ~,..¢~,,~z .......... ~ ....................................................................... b. Intended use and occupanc~ ' Nature of work (check which applicable): New Building'...~ .................... Addition ..................... Alteration ............... Repair ......................... Removal ....................... ~. Demolition ........................ Other Work .................................... ~ · · (Description) 4. Estimated 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 .....................Rear ........................... Depth ................................... Height ........................................................... Number of Stories ............................................................................. Dimensions of same structure with alterations or additions: Front .......................... Rear ......................................... Depth ............................................. Height ......................................... Number of Stories ........................................ Dimensions of entire new construction: Front ......................... Rear ............................ Depth ................................. Height ................................................. Number of Stories ......................................................................................... Size of lot: Front .....--""~;~,.~.~.'/. ................... Rear ....... __ ,, ,-3~/~..(~...::1. ................... Depth ......J..~';[-~. ................................ Height .................................................... Number of Stories ......................... / I'~: ....... ~'~:, .~ '0'j'~'.',~'r~'-'~ ......................... ~ Date of Purchase ..-~.....[..R..7...~ Name of Former Ow~ner ...;.1~:.~ ...... .~...-7~..~ ......................... 11. Zone or use district in which premises are situated :;~7~-.~.- ....................... 12. Does proposed construction violate any zoning law, ordinance or regulation: 13. Will lot be regraded ................................. Wil. I excess fill be removed from premises: [ ] yes 14· Name of Owner of premises ...~.....~..~'. ............ ~~ ......... .~..:~,.X.~.O..t~-2....~.~..>..':~..~..~......~.~....~ (Address) (Pho,ne No.) Name of Architect ...................................................................................................................... ~o~i~.~:i.,-~ ...... (Address) Name of Contractor ................................................................................................................................................... (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 n~nes and indic{~te wheth- er interior or corner lot. ~ 0 ,~.,~ ~c~', ~, oCo / STATEOF NEWY~)~K, ~_,~ ~ i ) COUNTY OF ........;~_L~.... ,~... ~.~,LP...[..1~ .......... ) SS ......~. ,7~,~..i¢.~,....~, ....~, ...;..~..;.,...;.~. ,..~.f~,~..,~, v~ ......... being duly sworn, deposes and says that he is the applicant above named. ~ (marne o~ inaiviaua~ si~ing~ct/ He is the ......... ~.,.,~.~.C~.~..~ ............................................................................................................................................................. ~ ~ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorj6~rhoTp~r~QL~ or have performed the said work and to make and file this application; that all statements contained in this applicatio~[~wtq~l~ ~h~o~s~o~ ~nowledge and belief; and that the work will be performed in the manner set forth in the application filed there~.52~o3~g963 s~{ro~k Co~g~ ~(3 ~ Com~P~ms ~o~& 3o,197~ ~/ /~ ~ · . ........ ,ot, .... ...................................