The URL can be used to link to this page

Home My WebLink About286-z FORM NO. 2 TOWN 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.° Sfi Z Date ............ ~]:IF,~. ~Lg. ...................... 19.~[~.. Permission is hereby .granted to: WII, We~e ...A/¢...A~.t,~uI'..~rAh~ ..................... .............. Be, y'lhc~, e..Boa~ ............................ ........................ 11~e$~l~r.t ~ .... ~,~ .............. to ...]~-l~l..an. ac1~.~.t~,~n...t~..ala..e~lt~2~., c~e~:l&n[. ............................................... at premises located at .--LO-t..il~..-~ .&..,,~9..-.]~O[l~e..bay. ............. : ........................... Ba3~.~hor. e.. lload ............................................................................... .............. : ......................................................... <tree~r.t~ .... ~..g~ .............................................. pursuant'to application dated ................... el~3Zt.~....~9 .................. 195~..., and approved by the Building Inspector Fee $....~'.OO .......... Building Inspector I~O~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ...... ~.../..~.. 19..~...6~' Approved ........................................ 19 ........ Perm t No ............................... Disapproved a/c ......... ................. Application No. ~ ~''& APPLICATION FOR BUILDING PERMIT Dote ..................... ....... 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 o detailed description of layout of property must be drown on the diagram which is part of this location. c. The work cov, ered 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 pui'pose whatever until a Certificate of Occuponcv shall hove 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 all applicable laws, ordinances and regulations,i ................. 57.:..: ....... ................................. (Signature of applicant, or na~, if a corporation) .............. ~....~ ~..~. .................................. ~ .......... ~ ............... (Address of applicant) State wheth,er applicant is owner, lessee, agent, ~chitect, e~ngineer, general contractor, electrician, plumber or builder. Name of owner of , _...,_e ....... ~ ......... ~ .............................................................................................................. 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: .~?.....?.~....'~Z~.....~Lot No: 3~'~ St reet and Number ...~....~.. ~Cr~i...~,(....x~. ....... ~.,~.:~. ..............~..~..~.....x.I../...~... ........................ Municipality 2. State existing use and occupancy of p~emises and intended use and occupancy of proposed construction: r;n · a. Existing use and occupancy ................................................~ ....................................................................... b. Intended use and occupancy ................................................................................................................................ 3. Nature of work (check which applicable): New Building .................... Addition ........ ~.Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... (to 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, specify nature and extent of each type of use .............................. 7. Dimensions of existing structures, if any: Front ............................ Rear ............................ Depth ............................ Height ............................ Number of Stories ............................................................................................................. Dimensions of same structure with alterations or additions: Front ................................ Rear ................................ Depth .............................. Height .............................. Number of Stories ................................ 8. Dimensions of entire new construction: Front ............ ~ ............ Rear ............. ~. .......... Depth ....~... Height ............................ Number of Stories ..... ~."~ .. ......... 10. Date of Purchase ..........~ ......................................... Name of Former Owner ..................................................... 11. Zone or use district in which premises are situated ........... i"~.~ ............ ~-~.~' ............................................. ]2. Does proposed construction violate any zoning Iow, ordinance or regulation? ............. ~.,~ ................................ 13. Name of Owner of premises...~-~,~.~....~c,.~-~Address ........................................... :Phone NO ..................... Nome of Architect ........................................................ Address ............................................ Phone NO ..................... 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 '//'Jo STATE OF NEV~ YQP~K~, ) S S. COUNTY OF .................................... ~ ....... ..~.'..~...L...~......~r.; ........ being duly sworn, deposes and says that he is the appli~nt (Nome of individual signing application) ~bove .~med. ~e ~ th. .................................... ~:~.~...~ ........................ ~...~. ........ ~Co,t~cto,. ~ge,t. co~por~t~ officer, ,tc~ ~~ ................... of said owner or owners, and is duly authorized to perform or have performed the said/~d~ to make and file this application; that all statements contained in this application are true to the ~st ~-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 ............ of ...... ................. ...... Nota~ Public, . ........................................................... County (Signature of apphcag~t) ) '!, ,~'~',~ ~