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Home My WebLink About1349-z FOB, M NO. 2 TOWN OF 5OOTHOLD 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? 1349 z Dote ......................... ~e~. '"'~9 ...........19~... Permission is hereby granted to: G.~ .Sm,i.th..&..*~o~...A/.6....~p~a-~k~..G~[c~er ........ ............. ,~.%~o.1~.~....* .~ .~ .............................. to -*.-B~. 1 .~..~e~..(~.ne..-~em~i.ty...~t~e ~..]:.i~ .................................................................................. at premises located at ...~,~/~......~Ol~h...~l....l)~,~r~.~ ......................................................................... .......................................................... 8~U~.~o.].~.~ '""~';'~Z:' .................................................................. pursuant to application dated ........................... ~S~J'~:J~ ....... ~ ............ 191~.~..., and approved by the Building Inspector Fee $. lO...OJ~J .......... Building J nspec',t~r j FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ 1c) ........ Permit No .............................. Application No..../..~,.~./..~ ............ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typew,riter 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 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 whot&~/er u~til a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HERE,BY 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 laws, ordinances an~?regulations. / ~ 7;. ......... ............................ (Address of appJidont) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on .w.h.~r~~)~.~.~.~..~.~...~/..~.~..~'~....i~,i~;~.~..~...~.~ Street and ~umber ...................... Municipality 2. State existing use and occupancy of pr. emises and intended use and occupancy of proposed construction: a. Existing use and occuponcy....K~...~...~.~...~..'.:.~.. ....... ~'./...~./..~.~..' ......................................................................... b. Intended use and occupancy.....,/~....~.~;~.~....~'~*~./...:'~.~. ....................................................................... J A 't 3. Nature of work (check which applicable): New Building .................... ddi ion .................... Alteration .................... Repair ................ ....~emoval .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost........-~.,.~.....~....~..~...o.....'..-:.. ........................ 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 er 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 .s~.....'~... ................. Depth ....~....~ .............. /. Height ........ i.~... .............. Number of Stories ....~?,..'~.,.,~- ........... 9, Size of lot: Front . ./..'...~....O. ............... Rear ../...~....~. ................ Depth .~.:,~."~..4, ................. 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ................................................................................................ 12. Does proposed construction violate ar~y_ zo,nin,g law, ordinance o]' regula~n? ...... :..~...?. ...................................... 13. Name of Owner of premise~,'~.~....Addres~~.~.... .............. Phone NO. ~....7..../,~-... .... Name of Architect ..........~ ............. ~ .......... .~ ....... ~ ...... Address ............. z. .............. ~ ....... ;.~...Phone NO ..................... Name of Controcto~.,.~..~..~'kr~..~..~.~...Address ..~---~--~¢n~..~.... ...... Phone NO ..................... PLOT DIAGRAM Locate clearly and distinctly ail 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. ST^'rE S X? ........................................~~'~'-,~'~r~~..~ ~~~. ,/~.......~l~eing duly sworn, depose~ and says that he is the applicant (Name of individual s~in~ op~licati~~ (Contractor, agent, corporate officer, etc,) of said owner or owners, and is duly authorized to perform or have performed the said work and to~ake and file this app cation; that all statements contained in this application are true to the best of his knowl~e and beef; and that the work will be performed in the manner set forth in the applicat~ filed therewith. ~ ~ Sworn to before me this ~ , ~ot~ ELO/S~ '~OW~'-- ~~ ............ of Nota~ Public, ~.~~ ........... ~.....:~ounty gXmres ~areh 30, Zg/~