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Home My WebLink About1018-z FOI~M ~0. ~ TOWN OF SOUTHOLD ISUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 1018 Z Dote ................... ,!L..A~.~..._.~ ............. ~9.6..0... Permission is hereby granted to: ............ Pt~e..~e~**P~d .................................. .................... ~,.....~,.~,. ........................ to ......... ~.~ .. ~e~ ..~...~.~...~_~.~ ............. * ................................................................ at premises I~ated at ~.....P~..~..~O~ ............................................................................... ...................................................... ~...~ta~e.~.~, ....~.~ ................................................................... pursuon~ to application doted ............................... ~.~. ....... ~ ........... 1~..., and approved Ey the Building Inspector Building Inspector · 0~ NO. I Approved TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 19....~.~ ig.~..Permit No ........... ~ . .,'~..~. -~.....~.. Disapproved a/c ............~ ................ ~ ...... ~ APPLICATION FOR BUILDING PERMIT Date 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 prem ses or public streets or areas, and giv~ing a detailed description of layout of property must be drawn on the diagram which is part of this location c: The work ~overed 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 ssuance 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 terat OhS, or for remora or demolition, as herein described. The applicant agrees to comply with all 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, electrician, plumber or builder. ............................................ ....................................................................................................................... Name o, owner of premises 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: ............................................ Lo No: .................... Street and Number ~/~. ~ ..~..~ J~ /~O ~ ~,~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ......... .J~....,~.....r-.....r;~...;.._~.,.,,...~.....~.....~. .... .... b. Intended use and occupancy ,..~ ,, 3. Nature of work (check Which applicable): New Building ........ ~ ........ Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ......... 2 .............................................. tee ....L~ ................................................................................ (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, D mensions of entire new construction: Front /'J'{~ Rear /-H L~ Depth ....... .?....~ .............. Height ............................ Number of Stories ................................ 9. Size of lot: Front ...... ./....O.....~.. .......... Rear ......... ./...'?...? ......... Depth ..... ../....~...O......~....~:~ 10. Date of Purchase ...... i ........ ./..~....'~'.....~'.. ................... Name qf Former Owner ..~....~.~ ...................... .... 11. Zone or use district in which premises are situated ................ /~ .............. ~.<~....-7~****' ......................................................... 12. Does proposed construction vio~te 9ny z~ning law, ordinance or regulatiQn? ...A .................................................... 13. Name of Owner of premises....~...'. .":' .......... Address .,. /.'"~.~. ........... Phone NO ..................... Name of Architect .................................................... Address .......................................... Phone NO ..................... Name of Contractor ....... :...;..Y...:..:..;. .......... ~' .............. 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 whether interior or corner lot. STATE OF NEi~Y.Y.Y.Y.Y.Y.Y.Y.Y.~I~,/(.,.,,. ) S S · COUNTY OF ~i ..... ) ' ' " ........................................................ ::. ......... ~**..: ,.~.~:..: ...... D g duly Sworn, deposes and says that he is the applicant (Name of 'individual signing application) above named. He is the ~ ' ' · ..... (Contractor, agent, corporate officer, etc.) of sa d owner or owners and is duly authorized to perform or have ~rfo~ed the said work and to make and file th s app ication; that al( statemen~ c~tained in this application a~ tee to the best of his ~wle~e and belief; and that the work will be performed in the maq~f,sq~ ~ in the application filed ther~ith. Nota~ Public, S~te of New York Sworn to before_ ~ ...me this ~ C,t~,i~;o0~4~ep, i~S~farOic[ .... : ...............-- ~ ~ ~,day of .,.. ~ ....... ........... '9..~.~ ....