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Home My WebLink About242-zTOW~ OF $OUTHOLD BUiLDinG D~:PARTME~T TOWN CLERk'S $OUTHOLD, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.° 242 Z Permission is hereby granted to' pursuant~,to apphcat~on dated ......... ~Jll~t~J~,..;J~ ........................... 19..~., and approved by the Budding 'Inspector Fee $~,~ .......... , .... Building Inspector FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ....... ........................ ........ ~r~ve~ ........................................ 19 ........ Perm:t ~o ............................... ~Z~rove~ ~/c ................................... ~ .......................................... ................ ~ .......... ~ .~'~'..~ ~.~,~'~"~'-'~:~ .................... r ........... Application No. "~ ~ ~ APPLICATION FOR BUILDING PERMIT Date ............... ...... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and suJ)mitted 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 o detailed description of layout of property must be drawn on the diagram which is part of this location. c. The work covered by this apl~lication 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 a Iterations, or for removal or demolition, as herein described. The applicant agrees to comply with ell applicable laws, ordinances oj~JI regulations: / c (Address of State whether appli~ is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises ................. ! ..................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on whic, k p~'oposed work will be do~e. Map No: ............................................ Lot No: ......... ~4 ........ 2. State existing use and occ~ncg of premlse~d intended use ond occuponcy of proposed construction: b. Intended use and occupancy ................................... ~.....~.C~ .................................... 3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration .................... Repair .................... / --~i~'-Rem°val ............. .~.....De, moli~tio, n .................... Other Work (Describe) .................... 4. Estimated Cost.~.....~f~.....~fL.~....~....~.....E-.'....Fee ...... ~.,..<~r~_,,,- .................................................................... " --~ ( of~be paid on filing this application) 5. If dwelling, number of dwelling units...~ ........... Number of dwelling units on each floor ............................ If garage, number of cars ............................................................................................................................................ 6. If business, commercial or mixed occupancy, sp~ci~fy~nature and exte~t/gf,pach type of use...~.~4....~ ............... 7. Dimensions of existing structures, if any: Front....~..."~.....''' ............ Rear..~.....~:..~.. ............... Depth ..'~.....'~.. .......... He'ght ./~... ................. Numb o Stones ................................................. ~. ............................. ~.~S;...~ ............. f t t th It t o s r ,t,ons Front ~'/~:~ Rea Dimensions o some s ruc ure wi a eratj n o add' ' : ................................ r ................................ Depth ....4....f~ ................ Height ..../....;.>. .................. ~ ~Number of 5tones.f/..,.= ..........................J~--~ 8. Dimensions of entire new construction: Front....7... ................... Rear .f-.. ...................... Depth ~.. ......................... Height '"l~" ............... N~mber of Stories~.u~ ....... /,~ c ~' ~ 9. Size of lot: Front ....~'..~ .................. Rear ..................... Depth/...... ......... ~.../G...J/..%/ .~fr r~l'r~ ~'~'~ ~-~ ~, r ,,~...~Zone o.~s~ d~,,~t~fi~promisos ore situated ....... ~.~...[......!.~.~..~ ................................................................. 12. Does proposed construc'iion ,giolate~ny zoning law, ordinancex, pr regulation? ...... ,~2 .................. 13. Name of Owner o prem's,.e.~~.~;]../...L:..~; ......... Addres~ ..~;.~ ......... ]i:_..:j_........~. one N~.'. ................... Name of Architect ........................................................ Address ............................................ Phone NO ........ ;.z'.= ....... ............. ; ............. ' ................ Phone NO ..... :.-:;: ........... Name of Contractor .......................... ~Z~ ...................... Address 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 J?terJor or corner lot. STATE OF NE~ YQRK, ~ ) S S 24' (Name of individual signing application) above named. He is t~e .................................... ~'...'~-..,'~, ..' ............................................................................................. (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'~l~plt~9~on are true to the best of his knowledge and belief; and that the work will be performed Jn the manner set~'e~?J~,'~ .~f~,,,pplication filed therewith. Sworn to before me this .Z~.. ,..~. dav of ~ 19 '-% ~'~£;~;~?e0~u~tJ'l~ (Sgnature of app cant) · ' Notary Publ c, ~.~.~ .................... Eounty