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Home My WebLink About1340-z FORM 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? 134o, Z Dote ........................... ~e.Z~k....2~ ......... Permission is hereby granted to: Original Homea....A/C.... ~,award..~a~hr ach ................ ...... ~d~le...I.z~.-_~.~ ...... :...i. .......................... to .......... ~uild..~e~..o~e...£ami~..~ellin~ ............................................................................ at premises located at ...l~,..Pa~.~tah...~..&..i)ay. to,~..l{e&d ........................................................ .............................................. ~o,,~tl~ot~ ~ ..... ~,. ~'~ .............................................................................. pursuont to opplicotion doted ...............~ii~F~h ......... .~.~'. ...................... ]9~,~...., ond opproved by the Bui[ding Inspector Fee $....1.O...QO ........ Building I n sp~dt~r ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .......... ~.~.X/~/,~ ~ ~ .~ .~'. ;.~..~.. 19..~./. " , ' ' ..... Approved ......... ,?.?/r~:.!';.~...~..:-~....~..19..~.~'.;..X(.Permit No. Disapproved a/c ................ ~.~..;.T~.~.~:;,..~.? ....... · (Building Inspector} Application No. ~ APPLICATION FOR BUILDING PERMIT Date ..................... /....~.. t .............................. 19 ............ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and su6mitted 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 Budding Permit. d. Upon approval of this app[icQtion, the Building Inspector will issue a Building Permit to the appricant. 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 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 a Iterations, or for removal or demolition, as herein described. The applicant agrees fo comply with all applicable laws, ordinances and regulations. (Signature of applicant, or name, if e corporation) (Address o~ apPlicant) State whether applicant is owner, Iessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporat.e, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of [and on which proposed work will be done. Map No: ..~:z~,.~.~.,¢~..~ ......... i'. ............ Lot No: ~....~ ............ Street and Number .~..(~.?r~z~,.~..~ ....... ~...~'~..~,,.,.~(./.~, ....... ~.~,',~.:....~..-6/ ............... ~(~,.:~:L,~. ~.:./..: ./~' ............................... Municipality 2, State existing use and occupancy of pr.emises and intended use and occupancy of proposed construction: a. Existing useandoccupancy......~.~;.;~..¢,..:;:'r:.:....~T... ....... ~ .~..:.~..'..I .~ ................................................................. b. Intended use and p _. ............. _,__:-..,.., ...........%'. .................................................................................. 3. Nature of work (check which appllcable): New Building..L:..'.....M~......Addition .................... Alteration .................... Repair ....................Removal .................... Demolition ....................Other Work (Describe) .................... 4. Estimated Cost.......~..~..0...O....q...~. ............................. Fee ../...0.....~ .............................................................. (to be paid oh filing this application) 5. If dwelling, number of dwelling umts ....... ~ ...................... 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, Jf 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 ........ .?.....~..i .......... Rear ........ ~..:¢~.'.i ........... Depth .......... Height ............................ Number of Stories Size of lot: Front .../..]?-..~.. .............. Rear ............................Depth '~ / 0 Date of Purchase ....................... : ............................. Name of Former Owner ...... ..................... .; '..~.7.': .................... Zone or use district in which premises are situated ....... ./')..'.' ................................................................................ Does proposed construction violate any zoning Jaw, ordinonce or regulation ..................................................... Name of Owner of prem, ises....j~/~.L('.~.,r.:.c..~...'~...f.f.':.~'., ...... Address ...~..!.~.O.:r..~...:~..,.::~;:::~;....Phone NO ..................... "/~/ "~" ~'~-~ Addres "~]~'~'¢~' Phone ~O Name of Architect.......~.~,.~..~..:~.:¥~..:..:: ...................... s ..... ~ ........................................................ Name of Contractor..~../~...~.~,.w..~.....!..1,~rm~.~.,*~,/,( .......... Address ..... .,.r...~..:.;....'.~....u.~...: ......... Phone NO ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, end indicate oil set-bed dimensions from :cording to deed, and show street no ~es and indicate 10. 11. 13. property lines. Give street and block numbers or description whether interior corner lot. STATE OF NE'er/iA'?'f'""'' ) S S COUNTY OF ":"~"/2'Z~ ........... ) ................................................................................................. bein~ duly sworn, deposes and says that (Name of individu~ gni~-app~ation) ~, . . above named. He is the ..................................................................................... **ra~ ........... ~.~ ....... .~ ..... (Contractor, agent, c~ora~ offer, etc)~ of sa d owner or owners, and is duly authorized to perform or have per~orme~th~ said wo~k ~nd this (pplication; that all statements contained in this application are ttue~o~ best of ~Js/~nowl and that the work will be performed in the manner set forth in the ap~l¥~jO~ filed ~here~t~] Swart, ~ b~ore me this ~ -- ¢~' B~,~w Yor, Notar~ Public, ~/j~....~..'..j~UJ?'."K~..C~nw" t~ is the applicant ) make and file edge and belief;