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Home My WebLink About1101-z FOI~M NO. 2. TOWN OF SOUTNOLO BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING pERMIT (THIS F~ERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) · N? 1101, z Dote ...................... ~.'~:lt',j~.....7 ................... 19..60. Permission is he'reby granted to: ~tetnr..~..s....~.......:..~...c.......~r.~..~:~ ................ ~%~ituek ~ N. Y. ~o ..... Bmi~..~.. aaditten..~n.~n..exl~2in$ _d~l~ .................................................... ef )~e~ses ~oce~e8 ~ .'....~..~..~f...G~..~$ .................................................... ..... : ............................ f~ ......................... ..-~a~.t~k.~-.-.N~,.~, ..................................................... Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exe mined ........... .~6~..~........ 19..,~i~... Application No...., ,/, ./...~.../. ............. Approved ............ . .,~','~4~..../~. ·..... · ' 9 ...~..~.. · Per m it No ..... ..~....~.~.Z~?./.. ........... ~/~'~;~1/7~"~/-'~'~'~"'~-~/~? u~sapprovea a/c .................... ~ ........ ~._. .......................................... _ ~ / . ~ .............. 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 adioining 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 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 1S 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 herei~ described. The applicant agrees to comply with all applicable laws, ordinances and regulations. /r ~ ~ ,~, '¢~' "e" ,"~', ~(~¢~' ~¢'-~'~, * (,Signature of applicant, or name, if a corporation) (~)~,¢(~f,¢, , ~;~, ": ...... . ...................................... ~ ~r t~¢ (Address of applicant) State whether applicant is owner, lessee, agent, architect,~ngineer, general contractor, electrician, plumber or builder. Nomo o{ owner of premises ................................................................................................................................................... If opplicont is o corporoge, sion*turo o{ duly outhorixed officer. (Name and title of corporate officer) Street and number ................................ ...... /// Municipality 2. State existing use and ~'ccupancy of,~,,pr, emises and intended use and occupancy of proposed construction: a. Existing use and occupancy ......... ...~.......~. · ..~...~.. · ~.~ ~ ............................................................................... b. Intended use and occupancy ................. .t..x. ................... ...C~.....~.........~r...?...~ ........................................... 3. Nature of work (check which applicable): New Building .................... Addition ....... ~ ......... Alteration .................... Repair .................... Removal .................... Demolltion .................... Other Work (Descrlbe) .................... 4. Est imated Cost..../.j....(:T~:9....~ ..................................... Fee ..~ .................................................................................... (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 ............ ~..o. .......... Depth ....... ..~Z..~ .............. 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 ........ ..~.....o.. ............ Rear .............. ].~...~ ....... Depth ....... ./....O. ............... Height ............................ Number of Stories ...~ ............ 9. Size of lot: Front ......~ ........ ..~Re'~r~..'. ................... Depth ............................ 10. Date of Purchase .............. !...?..~.....~.. .......................... Name of Former Owner ...... ?........~~ .................. 11. Zone or use district in which premises are situated ......................... ~.~ ................................................................ 12. Does proposed construction vi~l~te .~. z~i~ing law, ordinance or re~u~tionP ........ ~ ...................................... 13. Name of Owner of premises.../.: ....... .~..~ .......... Address .....~....~.....~.o. ............. Phone NO ..................... Name of Architect ............................ J ,O ..// ~-~ r~ ......... .~. ................ Address ........................................... ~-"-~ ,t'~-~ Phone NO ..................... Name of Contractor....'~..:..I..[m~..~...~.~ ........ 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 NEWk-"'Y~r ) S q ........................... ../..L.../...~ ......... ~_~ ....................... being duly sworn, deposes and says that he is the applicant (Name of individual signing ap,~icatio~n) above named. He ~s the ............................ L~ ............................................................................................................................ (Contractor, agent, corhorote officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application ore 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 ............... ~... 19..~/,,0...,~, ,~ (Signature of app ic~nt)