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Home My WebLink About1751-z FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEFARTMENT 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? 1751 Z Dote ........................ I~r,..--~ ............ Perm~sslon is hereby granted to: ,a~j:l.~t ~.. bduta ............................................. · 3 3-~' "I;o~e ~' · :~'~er .' ..................................... .... l'~or s:?c' l~k ............................................... to .... ~t~:~"~'~"o~'e"~'m~t-ly "~reI~z~g: ......................................................................... at premises located at ~[~;..J~3.....l;toQot'l.~.o..~l~r ..E~,e~ ..................................................... .............. : .................................. ~et'{~ .....]~t~. -,ghoz' e ..;i~,o a.~l ................................................................ ...................................................... ~.~e~,m,,~; ............................................................................ pursuant ,~o apphcat~on dated .................................. ~ ..... ~ ...... 19~., and approved by the Buddmg Inspector Fee $-.'!.O~ (]~ .......... NO. I TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ctor) ' Application No...J/...~....~...(. ............ APPLICATION FOR BUILDING PERMIT Date ................ .......... .... 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 drown on the diagram which is part of this application. 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 pa rt 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 alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations//'~ 'g pp ' , or nome, if o corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................... ................................................................................................................................................... Name of owner of prem ses ............ .L..~.!.!...Jz....~..~..~.~.....~.. ...... ..~.....~.-~.~.....~..~ ....... ~...,........~..J'...~..~...~..'~. ............................................. if applicant is a 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: ........ 1.l...~....~' ..................... Lot No: .....~'..0~ ......... Street and Number .......... i ........... ..~....~....~....~...~C....0....~.....~... ...... ~....~...~. ........................................................................ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Existing use and occupancy ................. V../j~.....~....'~...., ....~. ~. ........... b. Intended use and occupancy ............. /...~. ~../.J--~.. ...... ~! L%.~../...~.: ......................................... V 3. Nature of work (check which applicable): New Building ....... ..~. ....... Addition .................. Alteration .................. Repair .................... ~ ,,~Rem°val ...~. .............. Demolition .................... Other Work (Describe) ........................ 4. Estimated Cost ..... ...~.../~/~.T..'~..e....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 or mixed occupancy, specify natureand 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 a~terations br additions: Front ................................ Rear ................................ I Depth ............................ Height ................................ ~!Number of St°ries.....c~...--- I. 8. Dimensions of entire new construction: Front ........ ~ ................. Rear ........... Depth ...~'-~ Height ............................ Number of Stories ........... /..:~.~ ............. .-,tl.. ~- 9. Size of lot: Front ......... .,.~,~.!...O.:. ........ Rear ..... (~.J.,..~,~.: ....... Depth ...~.../~..~.:..S. .................. I0. Date of Purchase ....~...~.-~?..,?...i....J..~.. ................... Name of ~.mer Owner ...~....O~....~.:.~....~'~.~'~../~.~......~.../..~.../..~...~...~ 11. Zone or use district in which premises are situated ................................................................................................ 12. Does proposed construction violate any zon ng aw, ord nonce or regu orion> ............................ 13. Nome of Owner of premises ........ Address .?...~.~..~..~....~T..~.V..:...F~..:.P.~,Phone No.~..:..~.T..~/ Name of Architect ...................................................... Address ............ ~ ............................... Phone No ..................... Name of Contractor .................................................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from prol~erty lines. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner' Jot. STATE OF NEV~¥f;~I~,Jr ) COUNTY OF .~/.~...!.;.~;~ ...... ) ~'~' .. .......................... ~.~....~ ............................ ~ ................. ::, ....... De ng duly sworn, deposes and says that he isthe 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 all statements cog, t~e~ ~is application are true to the best of his knowledge and belief; and that the work will be perform~ in~'~e~e~r~rth in the application~with. Sworn to before me this ~t~52.034~63 ................ ......... ........ ,, ......... o,o,y ........ .............................