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Home My WebLink About5768-z FO~,~g NO. ~ TOWN 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? 5768 Z Permission is hereby granted to: llazbre &IIt, a~ey ll&kelrt, el at premises located at .........~.~.....,~..~J,.]~A4[ ........................................................ ~.~"i .................... pursuant to application dated ............................... ~ ...... ~....., 19..~1~., and ap~'roved Building Inspector. ~ ' ~ Fee $...J...~..e....(~... ......... by the !' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ...... .~...~....~..~.. ......... , 19.Z...~. Approved vt 19..~ .... Pemit No..ff .~....~..~. ~ Disapproved a/c .... ~ ........................... APPLICATION FOR BUILDING PERMIT Application No..~... ......................... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan snowing Iocahon of lot and of buddings on premises, relationship to ad olning premises or pub c streets or areas, and giving o detailed descr pt on of layout ofproperty must be drawn on 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 progress 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 for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, (Signature of applicant, or name, if a corporation) ........... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer. ',~ (Name and title of corporate officer) Location of land on which proposed work will be done. Map No.: ...... 2~. ....................... Lot No . Street and Number ../~...../--.2.''/'''~''..r..~.(..~.../,...~...~....~.~.~:J)...~..~....O...~.. ............. Municipality State existing use and occupancy of pr,~p, ises and intended .use and occupancy of proposed construction: a. Exisiting use and occupancy ..../..)....~...~.(..~g)...~..,.~.~.~./..~,..~. .................................. b ntend · ed use and occupancy ................................................ ~ ....... . ............ 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describ~¢~..~..~ .......... Cost ............................................................ Fee 4. Estimated ~/~/d)~ ' .....~..~...'.... ~. .................................................................... (to be paid on filing this application)/ 5. If dwelling, number of dwelling units ....,'~. ..................... Number of dwelling units on each floor ...--~..Z..~.. ............ 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 .....z~...~..~. ............. Rear .....z~f~....c~...../. ................ Depth ....~...?.. .......... Height ~..~.:. ............Number of Stories ~ Dimensions of same structure with alterations or additions: Front ...~.~..J ..................... Rear ...4~..~..~. ................ Depth ~....C~..../. .................... Height ...-~...~:..(. ............. Number of Stories .....~... ........................ 8. Dimensions of entire new construction: Front .../...'~... ......................... Rear Depth Height ..~..../. ............ Numb~er ~f Stories .........~..; ..................................... ~.~..,; .................................................... 9. Size of lot: Front ..~...~'~..L.~.....z~.. ......... Rear .....~.. ............................ Depth ................................. 10. Date of Purchase .../..././.~../~...~.. ............................... h~gme of Former Owner Z~..../~..../~...?.......~.~../~.../..~ ............... 11. Zone or use district in which premises are situated ../~.~.~./..~.~.~.~.~...~. ......................................................... Does proposed construction vi~,late any zoning law, ordinance or regulation? ......~.....~. ................................................ 12. 13. Name of Owner of prem,se~.~.(' ~x_4Jr'~' .............................. ~' Address /'~72.!.~. ......./ZZ~'~]]?~... ................... ~'~6,'/'C,4 x-) ~honeUrE No.~. ........ ~x_ ~.....7.?/ Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Controct~.~..~..?:-~.~.~..~-.....Address ...~..;....ll~...~.+..~.(~...:~...~.-~.. ...... Phone No.~....¢~...~.'.~./....~.~ PLOT DIAGRAM Locate clearly and distinctly oil 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 whether interior or comer lot. ~. c'~ ~ ,A 6~/6- / STATE OF COUNTY OF ...S~~.....I' ' (Name of individual signing application) rj above named. He is the ....................................... ~ ....................................................................................... (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 and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Swam to before me this Notary Public ~'~"/~u-~..J....:.._.,':~~unty (Signature of applicant) ~'~ suffol~ Cou ntY~-2'.~O