The URL can be used to link to this page

Home My WebLink About1237-z ]FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERICS OFFICE SOUTNOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 1237 Z Permission is hereby granted to: pursuant to application dated ....................... 0ct.t~}.,~.~..,...l.-~' ............... 1950..., and approved by the Bui!ding inspector Fee $..~'..~..O..0. ............. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Disapproved a/c ............}7 ............... ~'~ ......................................... ......................................... .~,~.~ .................. .~.. i .T.-5~ ............................. ................. l ~...(... _'~.'i~..~<..'::~r:~ ................................ (Building Inspe(~tor) Application No. / ~ 3 '~ APPLICATION FOR BUILDING PERMIT Dat e......~...../..~.'~.. ....... ./.....~,~ .................... , 19~,.,.,0... INSTRUCTIONS o. 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 drown 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 Bu.ilding Inspector will issue a Building Permit to the epplicont. Such permit shall be kept on the premises ava, liable 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 o 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 all applicable lows, ordinances and regulations. ....... ............... (Signature of applicant, or name, if a corporation) (Add~s~' of qr~plicont) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......................... '7~'~, ,~5) " "'Nome of owner of prem'se If applicant is o cor~rote, signature of duly authorized officer. :. (Nome and title of corporate officer) 1. Location of land on which proposed work will be done. Mop No: ...J..~...:.:.....~.,~,~r~ ..... Lot No:.....~ ............. Municipali~ 2. State existing use and occupancy of,premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....~%5~...:..~.~:;J..Z.~.',~:'....{ ............. . ......... ~...:...... ..................................................... b. Intended use and occupancy ............... !.: ........................... g?.. [.. · ~..~../':.k~5...~. · · :~'iZ · .~....: ...................................... 3. Nature of work (check which applicable): New Building .................... Addition ....... ~..Y~..,..Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... \. Estimated Cost ...................................... Fee .................................................................................. ~ (to be paid on filing this application) 5.~ If dwelling, number of dwelling units ......... .~7%~.~ ..Number of dwelling units on each f oar .................................. 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 ....~...4' .................. Height ............................ Number of Stories ......(~,~ ........ 9. Size of lot: Front ........... l..O,.r~...~,... Rear ......... ./, o ~Z- Depth ....... ~....~....-n ........ - .gf..p~. ' 10. Dote of Purchase .............. i...?....~.!.~.).,..~ ..................... Nome of Former Owner ...... ~,,,$....:.,,.~...,,,,.~ .......................... 11. Zone or use district in which premises are situated ............ ;.',~..~,.'. ....... J.~.:r..~.¢. ........................................................... 12. Does proposed construct on v o ate any zon ng aw ordinance or reau at on ,,~{. ;) 13. Name of Owner of premises,...~:,X~[,~,~,~.~(~.,L:,~.r.V.:~ddress ..... .~/.:!..~....~..C.;..,-:~e..f:.~..... Phone NO .. Name of Architect .................................................... Address ............ :.: ........................... Phone NO ..................... Name of Contractor ........ i ........................................... 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, end show street names and indicate whether interior or corner lot. STATE OF NEV~¥/D~RI~/)/ ) S S COUNTY OF ...',W/.~:.:,~'~'~" ........... ) ' ' ... ein 'u, ........................ .~..~,.(~..:..~;z;.'; ....... :.......~.~...:'.;:..:'.;~ .................... b ' g d y sworn, deposes and says that he is the applicant (Name of individual signi~f~ app~Llication)z,,;~ ~1 / ~'f~ . .,.~above named. He is the ........................ D.~'.r~..'~.zrD,~..~..~'........~....=.....~::C.~:~ ................................................................... . \) (C-~tractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to p~form 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 Jn the manner set forth in the application filed therewith. f (Signature of app,ticant)