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Home My WebLink About56-zFORM TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: · l'e-~ee~..~,...~:]J.~.~b.e~....~:t.~...~":t,~' ..................... 1.5 .~.1... ,~ o ;L:~J.e~.t't~.. ~ ~, ..................................... ...... ~;~1~.,......¥.~ :. ............................................. to .~tzild .. ~& ..eric lo z~t l.o.. & ..hull& .ad~tlon .. f;.¢~ .. he~'~o.o.~ .................................. at premises located at lq.~..~L.~.~...~..e....~.ql~...,.......~.~..~..~.~....~9?...e:.~.. .... ........................................................ ....................................................................... "~ 9 pursuant to application dated ........................... .~.~......¢;~-~ ............... 1 ~...., and approved by the Building Inspector. Fee $..5.~...C~).. ............. FOEM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .......... ~....."~ .............. 19 ........ Approved .......... '' !~ ............. '..: ........... 19...~..~.Permit No.....,.'~'....?~......(~,,- ............ (Building Inspector) Application r~o ........................... APPUCATION FOR BUILDING PERM:T Date ................ .~~'...~:~...~.. ......... 19...5~...~. 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 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 alt applicable laws, ordinances and regulations. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrican, plumber or builder. Nome of owner of premises......)~,~C_//..~.[ / ......... .~.....k~..~..../...ff...~.....~..~Jrl ........................ If applicant is a corporate, sig~ure of duly authorized officer. ¥ (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No ................................... Block .................................. Street and Number ~j.~.~...~k~:.~:~.~..~...~..~.:..~..`T~.~..~..~...~.~.~.~h..~...~..`h~.~.~.~j..`~...~.~.~.~..~.`~`.~.%~¥~i~u~.(.~ ...... State existing use and occupancy of premieses and intended use and occupancy of prOposed construction: a. Existing use ond occupancy ................ ~ ............. ; ................... ..~....,..L::........~. ................................................... b. Intended use end occupancy ................................. ~ .............................................................................................. 3. Nature of work (check which applicable): New Building .................... Addition ...~....Alteration .................... Repair .................... Removal .................... Demolition. ................... Other Work (Describe) .................... 4. Estimated Cost ~ Fee ~ ~ (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 ........... ~..~.~..~m~.. .......................................................................................................... 6. If business, commerical or mixed occupancy, specify nature and extent of each t,/pe of use ......... //C...6../~....~.. ...... 7. Dimensions of existing structures, if any: Front ............~ ............. Rear ....... .~.~ ............. Depth ~ ' Height ....... /~ ............... Number of Stories ................. ~.~ ....................................................... ; .......................... Dimensions of same structure with elterotions or additions: Front .................. ~..~.... Rear ..........~.~..~ ........... Depth ......... ~.~..~ ............ Height .................. ~..~....Number of Stories ........... ~ .................. , 8. Dimensions of entire new const~ction: Front.....~ ................ Rear ......... ~ ........... Depth ......... ~.~ ...... Height ............................ Number of Stories ...... [ .................... ' ' / 9. Size of lot: Front ........ .~.~. ........... Rear .......... ~ .......... Depth ...................... 10. Zone or use district in which premises are situated.....~L...~.~ ........................................................................ 11. D~s proposed co~tructi~ violate any zoning law, ordinance or regulahon ....... ~ .......................................... 12. Name of Owner of premises ........................................ Address ............................................ Phone NO ..................... Name of Architect ...................................... ; ............... Address ............................................ Phone NO ..................... Name of Contractor .................................................... Address ............................................ Phone NO.' .................... PLOT DJAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate all set-bock dimensions from property lines. Give street and block numbers or description according to deed, and show street names and indicate whether nt~r Lcd. STATI~ OF NEW YORK, ) / 0 0 ~ COUIN~'Y, OF ............ · ........... ~ S S.: ~ , I ......................................... being duly sworn, deposes and says that he is the opplicont (Name of individual signing4~cation) above/named. He is'tl'~,..~,. .................................................................................................................................................... (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 3 ..... day ... "~ 'i: ': "~" ;ul, :ii'~-~"// ' [~ '....l~ j~..~....~.....~. -C~unty ~.~ingature of applicant)