The URL can be used to link to this page

Home My WebLink About1448-z FOI~M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE COMPLETION OF THE WORK AUTHORIZED) N? 1448 Z Dote ............................. .~.t-l..~......2. ............ 19.6..1..... Permission is hereby granted to: .................. !.~!~,~.~ ~. ~:~g.~ .~...~T.,.¥.: .......................... to . b.~ ~,Id. ,.n e.~z.. ~ua.. £~?.m.J,;1,~f...d.~ ~ ~I,.L~z.~ ..................................................................................... at premises located at ..Q.e..c.~..."L~.~..~...e..~..~.(~..~..~...~.`T`).~).~..~./~..~D.~..~.¢. ....................................... ................................................... ~Lv~,.~.-.t, :L~ ~.¢.k ....................................................................................... pursuant to application dated ......................... ~':g,~.....~ .................... 19~.1..., and approved by the Building Inspector Building Inspecto/ OF SOUTHOLD ~OIL~Di NG DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No../...~l..(.-~Jb r.~... ....... (Budding Inspector) APPLICATION FOR BUILDING PERMIT 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 c?ered~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 l~uilding 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 issuanoe 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 //~'¢;~,/~/ ~'47 ~:~¢¢' laws, ordinances and regulations. · .............................. Store whether opplicont ~s owner, lessee, ooent, orchitect, enfiineer, oenerol con~ctor~ electr~cion} plumber or builder. .................................................................................................................... Nome of owner of premises ......... [ ..................................... If applicant is a corporfi~e, signature of duly authorized officer. .......... (~ome onfl titlelo{ corp~te officer) 1. Location of land on which proposed ~ork will be done.. Ma~ No: .... . ........ Street and Number .C~..~.~..~ ...... ~;..:-..~~..~2.'...~.~~ 2. Store existino use ond occupancg o{ peemises ond intondod u~o ond occupancy of proposed construction: a. Existing use and occupancy ..................................................................................................................................... b. Intended use and occupancy ................................................................................................................................ 3. Nature of work (check which applicable): New Building.... ..........I/' ......Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............ J. ................ Number of dwelling units on each floor ............................ If garage, number of cars ............................................................................................................................................ 6. If business, commercial ar 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 ....... ..~..r. ........... Height ........ ~-,..~../. ...... Number of Stories .......... Z ............... 12. Does proposed construction violate any zoning Igw, ordinance or regu, lation?,.~..~.~" ....... ~'.~Z¢".~.....~...~..~. Name of Architect ......................... ~.~.~, ............. ,~.~.~....Address ................ .4. ......................... Phone NO ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate oil 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. I /u'/~ ~'/~" ' /-~ ~-- STATE OF NEW YORK, ) SIS I COUNTY OF ..... .~..q~..F-...O..%~...._,...) I'1 ""' ..../...Y~.../~'h~/./.~....Z~;..-~.....~....~'-./k~./,~.~....~/~.. ........................... 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 have performed the said work and to make and file this application; that al 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 ~fore me this ............ .... soy o, ......... ................ No. ~2~6903650 Nota~ Public, . .............................. ~.~..: ....... County Quu~ified Term gxpire~ ~arch ~0, I~ ,