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Home My WebLink About1809-z FORM NO. ~ 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.° 1809~ Z Va~e ....................... ~,;'~ ...... 6 ......... ]9.6z.. Permission is hereby granted to' ~te~Lla..~..Jaeo~g~s ................................... ....... hy..Ave ............................................... ............ l~,st; .,~is~l. an ................... :.:~ ............. to ...Imt2~..ne~..o~ne.. f~m~ ] Ir...&leLllLu~ ................................................................................. at premises located at ..~....~t, li~1~..~ .....................(l~.t, lLl'~..~,,l).~.~.~,,) ......................... ....................................... ~st.. ~ar.t oa~...l~..Y. ............................................................................. pursuant to applicahon dated .................................. ~Ttl~.~ ....... ~ .......... 19. (~i., and approved by the Building ,Inspector Fee $.~LO..O0 .......... FOR~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ..~ $OUTHOLD, N. Y. Examined ........... ~.. ......... , )9.~....~. Approved ........U ............. h: ............ , 19..'.L...Permi, No..~...~....~.....~ ........ Application No. '~'~'"'~'"l' ........... APPLICATION FOR BUILDING PERMIT Date ..~ ...... .f~ ............. ~....i., , 9.....~....~ 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 (3 detailed description of layout of property must be drown on the diagram which is port of this application. c. The work. covered by this appllcotion 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 i'nspection 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 o Certificate of Occupancy shall hove 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 , me, ~ a corporation) ......... ~ (Address of applicant) ' '~,,~ 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 which proposed work w/LJl b,e done. Map No: ..... /1.~.~,~ ...... Lot 1~1o: [~,.,~....~.. Street and Number ....... ~....~......~i~ii~...~../..~..~.~..~. ............ 2. State existing use and occupancy of premises and i .ntended~ and occu, B'ancyLo_f proposed construction: · - ': ............................ :"'"l ..................... /' ................................................. 3. Nature of work (check which applicable): New Building / Addition Alte tion Repair .................... Remc~l~,~ ~.~)..~,/.: ...... Demolition .................... Other Work (Describe) ....... .............. Estimated Cost ......................................... ~ .................. Fee ........................................................... .~ ......................... 4. (to be paid on filing this appl~ation) 5. If dwelling, number of dwelling u~__ ...~ ............ Number of dwelling units on each flo~/ ....... ~ .... If garage, number of cars ................................................................. ~ ............................... 6. If business, com~rcial or mixed ~cupancy, spedfy natureond extent of each t~e of use ................. ~ .............. 7. Dimensions of existing structures, if any: Front .......................... Rear .......................... ~pth .............................. Height ............................ Number of Stories ............................................................................................................. Dimensi~cture with alterations or additions: Front ............... ~. Rear ................................ Depth ............................ ~-~" Height .................. ~..~...~ber of Stories ....~~ ................ 8. Dimensi~f~t~construction: Front..~ ......... Rear .......... ~_.~.~... D~th .... ~..~_~... Height ........................ ~~f Stori~.....~.~ ........ 9. Size of lot: Front ......~......1~:~ ........ '~ ........... Depth ................... 10. Date of Purchase ........................................................ ~ Name ~..~ 11. Zone or use district in which~ ~__ ~premises are situated ....................................................... ~ ..................... : ..... 12. ~es pr~osed construction~~~~u~...~.~.~.~:~=~, 13. Name bf ~ner of premises ........................................ ~-- ~--~ ~----A~ress ........ ~ .............. ~ ....... ~one No ...... ;....~....~7' Name of Contractor ................. ~ ...................... J ........... Addr~s ............................................ Phone No ..................... PLOT DIAGRAM Locote clearly ond distinctly oll buildings, whether existing or proposed, ond indicote oll set-bock dimensions from property lines. Give street ond block numbers or description occording to deed, ond show street nomes ond indicote whether interior or corner lot. .................................................................~.~_.t~g4,~,~....~.:..,..l:)e~ .............. be'ng d~~s that he is the applicant (Nome of individ~,~.~,m~,~,,,~~ above named. He is the ......................................................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duiy authorized to perform Or have performed the said work and to make and file this application; that oil statements contained in this application are true to the best of his knowledge and belief; /Jan~that the work will be per~0rmed in the m..~r set forth in the application fil~l therewith. ~Sed~obefore me this ~ tlot~rv Put~lic, ?~BO'.~EN .,'"~-.t* '~/ ~ A ,,~ / /') ........................ c- y- .z :.. .................................................................. ...... · ,..~.,,, ~:~....,,,.. ~ , ~.,~ . . Notary Pubhc, ~ ................................ ~ (S~gnature of applicant)