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Home My WebLink About1225-zFORM 1~0. I Examined.....~ ...................... 19 ........ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ 19 ........ Permit No. ~ / ~-"~ ~ ...... ............. Disapproved a/c Applicotion NO...Z...~.....~...~.Z. ..... APPLICATION FOR BUILDING PERMIT Da,e ................. ............. 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 buildinglshall be occ(~pied 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 ~ounty, 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. .............. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....... ........................................................... ............................................................................................... Name of owner of premises ........... ~j~.~.~:.....~..~/'...l~...~.. ........ .~,~.... .......... ."~....~..-../.~....'..~/...'~.~..:..~.'~...-.~.~.'-./...~...' ........ ............... If applicant is a corporate, signature of duly authorized officer. v' (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No: ..~.....~.....~..././~....~........~'..~..!!..~'...../. Lot No: ......'~....,.~.....~.... Street and Number ...... ...'~...~......~.~...~.....T..~.....~..I ......... ~...O.~..~. ............... ./~.!..~...~...,~....~. :..~.. ......... ,.FI...~....J....~....,T.. ......... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .................. ...~,./~ ..~.,~.....~.....~.. · .......... · ./'Z.. · ./~'. · · · .~. · · .~. · ...................................................... b. Intended use and occupancy .................. - ' -'--~,.....~.....~.....~.-. ............. "--.~',..?.../-.~. ......... ..---~.....~.....~....~.. ..................................... 3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration .................... Repair .................... Re,~oval .................... Demolition .................... Othe£ Work (Describe) .................... 4. Est mated Cost : /..?~ .~t~...~. ...................... Fee ...................... ~..~..c..O.....~.. ................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... I. ............... 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 alteratiohs or additions: Front ................................ Rear ................................ Depth .............................. Height .............................. Number of Stories ................................ construction: Front ....... ~.~......i ....... Rear ....... ~1....~.. ............ Depth ¢.~ 8. Dimensions of entire new Height ........ ~/~..~,~ ............. Number of Stories ....... ./. ................. 9, Size of lot: Front ...... ----/~.~..,.~ ...... Rear ,.r,..~....~..-- ,,,~_ Depth ~ ...~....~?.. 10. Dote of Purchase ].~...~.~ ................... Name of Former Owner J~....~....~....~-,~..~.......~...~......~../~...~...~. 11. Zone or use district in which premises are situated .......... ~....~...~...~.. ...... ..~'..~.....~.....~...~....~....~....?..~..~ ........................ ]2. Does proposed construction violate any zoning law~ ordinance or regulation? .................................................. Nome of Owner of ....... Name of Architect ................................ ~....~...~.'.1~ ........... Address ............................................ Phone NO ..................... Name of Contractor .................................................... Address ............................................ Phone NO ..................... PLOT DIAGRAM Locate clearly and distinctly oil buildir~gs, 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. ' ' AFRR"a (Contractor, o~ent, corporate officer, etc.) o{ said owner or owners, and is duly authorized to perform or h~ve per{armed the said work and to this application; that oll statements contained in this application ore true to tho best of his knowledoe ~nd belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before this me C~ ....... ~ ......... da ,~ 19~ .... i~inn ~pir~ Marc~ ~, 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.o 1225 z Date ....................... O~.t,O~l'..... ';'~ ......... 1960... Permission is hereby granted to: ~.v..~..~..j.~..~c~Ll,~ ................................ ..¥ans.ton..Rond ................................................. ....... Cu.t~h~g~e~..... ~i. ~.. ................................... to .~l,;1.6,..z~m~...o~e...g. am~..'l.y..awe~.~.i-r~.... (.~a~.ia~lce..~.~.ant.~.) ..................................... at premises located at ....J,o.t..ijL.~.l.3...~t&sse~a...po~.l~...p~,opez,~ee~ ....................................... ....................................... ¥/~.....V.~natc~..Road ................................................................................ ............................................................. ~u.t~h~t" '" 'N'~'~ ............................................................. pursuant to application dated .............................. OlJtJ~be~l'....~ ............ 1960.., and approved by the Building Inspector Fee