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Home My WebLink About15-zFOP~M NO. :~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. [~IJILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No..Z..[~ ............... Permission is hereby granted to: · .:~dg~l~.&.Ilo~,o~ ............................................. ................. ~'~u~g~** ,.....~,.T,. ............................... to ..... *l~i.l~* * ~lt~on..to..ex$st,&~g.-~e~t$~4~ ................................................................................ ................... .~/o....:o~..~sr ........................................................................................................... at premises located at ,**.6~¢~**~01~:...(..]~/~[~-~4~) ............................................................................. .......................................................... ~p~.~.t,., ...... ~,.~.,. ........................................................................ pursuant to application dated ................................ ~....~L~ ................ 19...~.., and approved by the Building Inspector. .' FOI~M NO. 1 Town O~ SOOT.OLD BUILDING DEPARTMENT TOW~ CL~K'S O~FIC~ SOUTHOLD, N. Y. ............. ' 'g p o) Application No APPLICATION FOR BUILDING PERMIT 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 showing location of lot and of buildings on premises, relationship to adjoining 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 location. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Up,on 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 work. e. No building shali be occupied or used in whole or in part for any purpose whatever until o Certificate of Occupancy. shall have been granted by the Building Inspector. APPLICATION IS HEP~EB¥ 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 appJicabJe laws, ordinances and regulations. ................ : .............. ~';~;i~' ......... (Sig,~'ature~6f applicant, or name, if corp ' ) ...... ......... ~' (Address of applicant) ~' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrican, plumber or builder. If applicant is a corporate, signoture of duly authorized officer. (Name and titl~ o,f~corJS'orate officer) 1. Location of land on which proposed work will be done. Map No. ~'..c~ . ....................... B~ock ....~..~,,~,,,,,,~r~ ............ Street and Number ...~...~ ............................................................................................. 2. State existing use and occupancy of Rremieses ~nd intended use and occupancy of proposed construction: a. Ex~sting use and occupancy ...... .~.'~...~~ . . ............. b. Intended use and occuponcy.....¢~~..~ ............................... 3. Nature of work (check which applicable): New Building .................... Addition ..../.~ ........... Alteration .................... Repair .................... Removal/~ ................. Demolition ................... .~ther Work (Describe) ..................... 4. Est.mated Cost. ........... ,..,,~..~.. .............................................................................................................................. / (to be paid on filing this application) FEES: 5, If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ if garage, number of cars ........................................................................................................................................ 6. If business, commerical or mixed occupancy, specify nature and extent of each type of use ................................ Height ...... /..~...l. ............ Number of Stories ....... / ........................................... , ......................................................... Dimensions of same structure with alterations or additions: Front ........ .~....~. .................. Rear ...... .~....~.. .................. Depth. ............. ~. S ' .. ............ . .......... Height ../..~'..'. .............. Number of Stories ...... ~ ........................ 8. Dimensions of entire new construction: Front ....... ~/....~.. .............. Rear / ]' J Depth / ~ Height .......... ~.. .............. Number of Stories ....... ./. ................... ............................ Depth ....... 10. Zone or use district in which premises are situated ................................................................................................ 11. Does proposed construction violate any zoning law, ordinance or regulation? .................................................... e - - - .......... of premises ..... : ..... dress ~...~..:...~'..~/. hone NO. 12. Name of Owner Name of Architect ...................................................... Address .............. ./....Phone NO ..................... Name of Contractor~'.~...~ ............ Address ~.."' .............. Phone NO. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate ell set-back dimensions from property lines. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner lot. Sworn to before me this t' ...~.../....=: ...... day of .~ .......... ._. ........... 19...~..~y. ~ARZON 8. ARNOLD Pubhc, County Notary ' ' ......... ~O~'P~BH~ t~' tH~'$t~tPO{'N~WY~T~ '" No, 52-b106600 ~esidiug iu Suffolk ~ ~ Oomm{ssion Expires ~areh ~0,19...~ (Singature of applicant) COUNTY OF ........... ) S S.~----'~ -- (Name of individual"signing application) 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 ell 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 flied therewith. FORM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ................... '.; ................... 19 ........ Permit No .......... -~.. ..../.~... ........... Application No ......................... (Building Inspector) APPLICATION FOR BUILDING PERMIT 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 showing location of lot and of buildings on premises, relationship to adjoining 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 location. 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 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 Soqthold, 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 and regulations. .... ............................................. 'g DP ' , m , if a corporation) · , , ............... (Address of applicant) ~' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrican, plumber or builder. Name of owner of premises....~......~...L...~~. ........................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of ~'orp~raf'e officer) 1. Location of land on which proposed work will be done· Map No.....~.,~;i~..~.~ .... Block ........ / .~.....'~.,..~...('~. State existing use and occupancy of premieses and intended use and occupancy of proposed construction: a. Existing use and occupancy.....~....~...~ ............................................................. b. Intended use and occupancy..~~~. ............................................................... 3. Nature of work (check which applicable): New Building .~ .................. Addition ....... ~ .......... Alteration .................... Repair .................... Removal ...~.//~ J ,,,~ 4'~/'z-~Dem°liti°n ................... .~.ther Work (Describe) .................... 4. Estimated Cost .......... ..~.4.~....~...~.~...... ................. Fee ..~..~.,.....c~... ............................................................................. (to be paid on filing this application) FEES: 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, number of cars ........................................................................................................................................ 6. If business, commerical or mixed occupancy, specify nature and extent of each type of use ................................ Or 7. Dimensions of existing structures, if any: Front ......... .~. ................ Rear ....... .2r.....6]...~ .......... Depth ....~ ............... Height ...../.~.. ................ Number of Stories .............................................................................................................. Dimensions of same structure with alterations or additions: Front ....... ~...~....~. ...............' Rear ..... ,~...~.. ................... r ......... ./.~...~ ............. Number of Stories Depth ......... .'~ ~.. ............. Height ................................ 8. Dimensions of entire new construction: Front ......... /...~...! .......... Rear ......... /...?,...I. ........... Depth ...... ./..g~. ............. Height ...... ./.~J .................. Number of Stories ........ ./. .................. 9. Size oflot: Front ~2'0Or Rear ;~0 O r ........................................................ Depth ............................ 10. Zone or use district in which premises are situated ................................................................................................ 11. Does proposed constructiot~ violate any zoning law, ordinance or regulation? .................................................... 12. Name of Owner of premises. .. ddress .~~..:..~'...~/one NO ..................... Name of Architect ...................................................... Address ............................................ Phone NO ..................... Name of Contractor.~....~..~ ............ Address ..~ ................ Phone NO..,O,~..%~..T'.~'...~..~...~ 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 numbers or description according to deed, and show street names and indicate whether interior or corner lot. lA7 STATE OF NEW YORK, ) S S COUNTY OF ............................ ) ....~/~.~...~...~..~.../...Z.~..~~..'"'"..".'.""".'".'.".".'"being'"' '~ -- "- ~-- --'" "- -"-~"- ~ -'-'"' duly sworn, deposes and/'/Says that he is the applicant (Name of individ6'al s'~gning application) 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. Sworn to before me this ..... ~../.......~....... day of ....~-...~:~. ................... 19.~...?/... MARION $. ARNOLD Notary Public, ............ ~T6,~y ~t~bti¢~ ~l~e ~a~ o~. ~a~ .~.or~..Cou nt y No. 52-5106600 XResidiug i~ Suffolk Cotmty M ~- Commission Expircs March 30, 19---¥-.-,~ (Singature of applicant)