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Home My WebLink About1038-z FOI~M 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? 1038 Z Date ........................ A~&'~'" "'~;~ ............ ]KO .... Permission is hereby granted to: T~rr.y...L..G~e~ .................................................. ................. -~rezee~t..eve ................................. ............................... ~her ~r ...Z~t~-~......~-~.~ to ...~u~t~...am...ad~i.t.~en.. em..a~., e~.~.e t,~.ng .. ~'~ett.~m~ ...................................................... at premises located c~t C,r.e,~en~..A~e,,.~ ............ .F~hez~,~..~.~lez~,......~I~.~, ............................ pursuant to application dated ......................... ~k~ 'J~ ....... .~ ...............19~0..., and approved by the Building Inspector Fee Building Inspector Examined .......................... ~ , FOP~M NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No ................................. Approved .................................... , 19 ........ Permit No ................................. Disapproved a/c ..................... ~~ i~. ....... (Building Inspector) APPLICATION FOR BUILDING PERMIT Do;e ................ .................. ,i9 ........ ~NSTRUCTIONS 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, ond giving a detailed description of layout of property must be drawn on the diagram which is part of this location. c. The wo~ 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 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 a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of o 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 appl cant agrees to comply with all applicable laws, ordinances and reflulations. ~ "'icant, or name, 'if a corporation) .... ......... ...................................................... ............................... iX;~Li~;~';';;~"~'~'~i'i~;;~B ............................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. '/, ........... .............. : .......... .""; ....... '/:,'f .......... ....... ............................................................................ r~ame or owner oT premlse~ ...... ~ .................... ~ ........................................................................................................................ If applicant is o 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: ............................................ Lot No: .................... Street and Number ..................................................................................................................................................... Municipality 2. State existing use ond occupancy of premises and intended use and occupancy of proposed construction: o. 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) .................... 4. Estimated Cost .................... Fee ....... :..-zm.. ............................................................................ (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: Fronl ....... ..~.~....(?. ......... Rear '~ ~' Co t ';~ ? ............................ Dep h ................................ Height ........ ./....~. .............. Number of Stories ........ z~.:. .............................................................................................. Dimensions of same structure with alterations or additions: Front '~( '~ ................................ Rear ................................ Depth ................................ Height ................................ Number of Stories / 8. Dimensions of entire new construction: Front .. / :~ Rear ~ ~ Depth I Height ............................ Number of Stories ................................ 9. Size of lot: Front .......... ~...~. ........... Rear ....... .~....~. ............ Depth / ~O 70. Date of Purchase ...................... ~. ................................. Nome of Former Owner ~"~'~- ~c~ 11. Zone or use district in which premises are situated ......................................................................... 12. Does proposed construction violate any zoning Iow, ordinance or regulation? ..~ ............................. 73. Name of Owner of premises ........................................ Address .......................................... Phone NO ..................... Name of Architect .................................................... Address .......................................... Phone NO ..................... Name of Contractor .................................................... Address .......................................... Phone NO ..................... PLOT DIAGRAM Locate dearly ond distinctJy 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 NEW~,YOI~)/-,/£ ) S S COUNTY OF ....%t..~:!'. .......... ) ' ' H ............................. :..... ........... ~':.~.......k.......~.~.v.: ....... being 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 said owner or owners, and is duly authorized to perform or ha~e 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 in the manner set forth in the application filed therewith. Sworn to before me this ........................ day of ......... ~.'i!~')"'""*""~"~.,~i'~ ............ lc) ............ t Notary Public, . ........................................ Court y (Signature of applicant)