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Home My WebLink About4755-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? {755 Z Permission is hereby granted to: ............. #;12,,1,1,mm~.. ~G..~...W ~,~ ................... to ............. JJla.i~d.. ~ .. f~..&~ ................................................................................ at premises located at ................... ~lt~...l.0~ ......JJ~....J/~,~l~l[ ............................................ ................................................ ~J~m ......... ~o1~. ....................................................................... pursuant to opplication dated .......................... J{~.~ ....... ~.~ .............., 19...~0, ond approved by the Building Inspector. Fee $...J.G~,J)~J ........ FORM NO. I 'T~OWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ........ ~..:..' [ 19.~. ..... Approved ........................................ , 19 ........ Permit No ..... ~... ........ -~....~.,~ Application No.../. .......... ~ ............ (Build~fil nspector) APPLICATION FOR BUILDING PERMIT Date ............................... ~ .......... ~.~ ....... , 19.2.0 ...... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink und submitted in d~plicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to ad pining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this application. c. The work covered by this application may nat be commenced b~fore 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 progress of the ~'ork. 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, cnd other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, os herein described. The applicant agrees to comply with all applicable laws, nrdinonces, built, lng code, housing code, and regulations. .... ............. (Signc~d'~e~r'appli~aht, or'hame, if o/~.orpo~tion) (Address of oppllca.~t) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ............................................... ~,~me~-..,,..'b~f~i<~e'r ............................................................................................................. Name of owner of premises .......... ¥.'.~.T].~m..~.~....~ar~e:~'e.l~..t~a~e~ .............................................................................. If applicant is a corporate, s~gnature 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 end Number ............. ~/~8'"..~a"J.~..~oe~J .......... (~tt~l~Jn-O.[E~e .........J[,,~o ................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .............. .¥~8.L~;...~t~J,....'J~t. ............................................................................... b. Intended use and occu~onL' . ......... ~il~....&r.~.~.~, c'L~I~.?L.,1.~ ................................ 3 Nature of wo~k '.'chec!( whicl~ aoplicable): New Building ..-~E~I: ........ Addition ...... Ai:er~:hc.c Repair ............... Remova~ .................. Demolition .................. Other Work (Describe) 4. Estimated Cost ...... ~.i~e~)....~. ................................... Fee .....~O.,,GD .................................... (to be paid on fi'lng th~s opplizotion) 5. If dwelling, number of dwelling un,ts ...... .O~1~ ............... 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: F~on~ .......................... Rear ................. Depth ....... Height ...................... Numb6r of Stories ..................................................................................... D!mensions of same structure with alterations or additions: Front .............................. Rear ....... Deplh ............................... Height ......................... Number of Stories .............. 8. Pim~.ns/c, ns of en~-iru new construction: Front ....... L~)...~- ................... Rear ..........,'J.Q~ ........ Depth ..... ~(~/....~P Height ................... Number of Stories .......... Q~ ................................................. 9. Size o~: lot: Front .....~...~ .......... r~tegr ............. ~.,~....e ............ Depth ....... "].~:'~...i ... 10. Date of Purchase ................... ~1~)~ .......................... Name of Former Owner .... J:~e].l;,~Z" ........................ 11. Zone or use district in which premise.¢ are situated .......... b-,d.'...~.S.t. .................................... 12. Does proposed construct;on ~iobte any zoning law, ordinance or regulation? ...... ;'~f: ....... 13. Name of Owner of prom!sos ....~i.,,../~,~,~Zl. ................ Address ...... C,~l~l;P,,.Jrto~ .......... Phone No ...... No-ne of Architect ......................................................Address ........................................ Phone No ........ Name of Contractor ....... ~e ...................................Address ...................................... Phone No ........ PLOT DIAGP, AM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and b!ocl', number or description according to deed, and sho,v street names and indica,e whether interior or c¢:rner Jot. STATE OF NEW YORK, IS$ COUNTY OF .......... ~u~.£~],k...=J' ' ' ................................... ei;l~..,~l~,..o-~,~t~ ............................. being duly sworn, deposes and soys that he is the applicant (Name of individual signing application) above named. He is the .............. ~'~1~...,-,..i~1,1$.,~1.~ .................................................................................................... (Contractor, agent, corporate officer, etc.) of said ow~er or owners, and is duly authorized to perfon'n 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 .. ///,// ~. .................... ~..~ day of ......... ~ ....... ~,~ ................... 19....2~ · ? '" /~.,//~ /'~ ' Natal, ....... ........ ";~.~,',~-',/ (Signature 6f applic6nt)