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Home My WebLink About2317-Z FOBM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 2317 Z Permission ~s hereby granted to: ................... ~e~L..Rm~ .................................... to ...... ]l~.t~-.e~..e~o~" ~n..m~-.e~ s~ir~"~l~e!t.~ ................................................... at premises located at ......~i~.....~ell 1 l...1~:~l~. .................................................................................. .............................................................. · .aa~me~r .~v.~. ....................................................................... pursuant to application dated ........................... ~llla~....~l. ............ 19.~!.., and approved by the Building Inspector Fee $-5,,~X~ ............ ' ' ' Building Inspec-foT ~ -1 ,a~ %~2~ 3~o~),2-~ - C~':D3~ TOWN OF SOUTHOLD BU U.."DING DEPARTMENT TOWN CLERK'S OFFICE Application No. Approved ........................................_.' 19 ........ Permit No. '~,? '" .............. Disapproved a/c ............... ~ ........................ ~ ............ " .......... , _, ......................................................................................................................... ~h{s ap~ion I n~or. b. Plot plan showing I~otion of lot and of buildings on premiss, relati~ship to adjoini~ p~i~ m ~1~ ~ ~ ~ ar~s, and giving a detailed d~r~tlon of [o~ of p~must ~ drown ~ the di~mm ~ich Is ~ M ~ls ~li~ ~ c. The work c~ered by this applicati~ m~ not be commenced ~ i~uance of Building Pe~it. d. Up~ appr~al of this application, the Building Ink,tot will i~ue a Buildi~ Pe~it to ~ ~llcanL ~ ~ permit shall be kept on the pmmi~ available ~r insp~tion thmUghou[ the p~mss of t~ ~ } e. No building shall ~ ~c~i~ or u~ in whole or in ~ for any pu~se whet~er until a ~ifi~ of ~cu~ ~ shall have been granted by the Building Ink,tot. /??7 Rte ............ ...... ......... , ..... ~ / INS RUCTIONS ~ must be completely filled in Dy ~ypewrirer or in ink and s~Vmitt~Un duplic6te to the Bui~ j 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, Now 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 and regulations. ......... .................................................... :... (Signature of applicant, or name, if a corporation) .............. .................................... (Address of applicant) 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) 1.' -Location of land on which proposed work will be done. Map No: ...... ~ ....................~]..~ Lc~t No: ..~ ........ /~ Street and Number ~.....1~.4l~]Jl..~t. lHl.~...~l~l~.fll~,~ ......................................... ~!.....i!......Z"~.."~.!~ .............. /'~ / ~ / ~'~- Municipality · 2. State existing use and occupancy, of premises and inten~led use and-occupancy of proposed construction: *'i a. Existing use and occupancy ..d3Eel~:Ll~ ............................................................................................ i ................. b. Intended use and occupancy II ~/ &ddlt~a~ .................. ~ Alteration ~ 3. Nature of work (check which applicable): New Building Addition .......: ........................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .' ..................................... 4. Estimated Cost ........g~,~..~J~. ............................. Fee ....~..~.(~) .......................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ..,.O~HJ ................. Number of dwelling units on each floor ............................ If garage, number of cars ..............~111~ ..................................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............ * .................... 7. Dimensions of existing structures, if any: Front ......... .~r~. ........... Rear ........ ..~. ............ Depth ..~..~.~ ................ Height ............................ Number of Stories ..O~A~ ............... : .............................................................. :....:.:~,: ........... Dimensions of same structure with alterations or additions: Front .............. ~6 ............ Rear ...~ ................. ..~. ..... Depth ......~.l~../.~.6 ............ Height ......................... j....Number of Stories ........................................ 8. Dimensions of entire new construction: Front ....~,.~ ...................Rear ,~ ............... ~. .......Depth ......~.~.~ ................ Height ............................ Number of Stories ,..t~.~i ......... ; ........ -' ' 9. Size of lot: Front ....~ ................. Rear ............................ Depth ............................... 10. Date of Purchase ....................................................... Name of Former .Owner...,,;.~ ................................................. 11. Zone or use district in which premises are situated .............. .?~.?...~d~.~. ............................................................... 12. Does propo.~ed construction vielate any zoning law, ordinance o~? regulation? .......... ~ ........................ ' ........ ~ ..... 'I~L Name of Owner of premises :eT~l~13...~l'.~..~O~e~'. ....... Address ............. ~1~.~.~ ................. Phone No ..................... Name of Architect ............................... : ...................... Address ................................. ; ........... f~ene No ..................... Name of Contractor ................................................... ~:Address ........................................... Phone No. .................... PLOT DIAGRAM ;~ Locat, clearly and distinctly all buildings, whether existing or proposed, and indicat~ all '~et-back dimensions from property lines. 'Give street and block numbers or description according;t~eed~,-~ehow street names arid indicate whether interior or corner lot. : · ~' STATE OF' NEW YORK, L S.S. -C'OU TY OF ........... I ) / ....................... ~O]l~L~vg..~..~_~. ............. : .......... : ................ being duly .sworn, deposes anc~ sqys that he is the applicant (Name of individua~ .signing app icat on) above named. He is the .............. 0~l~...~..~bl~t,~-l~l,e~' ...................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have per~ormed the said work and to make and file this application; that al statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed 'n the manner set forth 'n ,the appl'~:at'an filed therewith. Sworn to befdre me this ..... ................... .~...~... dcLvof ..: ................ ,~t~.~ ............ , 19'(J~'" ~ ~)