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Home My WebLink About1851-z FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. N.o 1851 Z Date ................................ ~'1~.ii~;'""i'~" 19..~. Permission is hereby granted to: Ne~..~o.~k--SlztI~ ................................. ................ New..b'ul'fo. lk ...................................... to ... b-~l, ee ~.. 'al~l" ma:l.~ta in" ~"' ~tlt,'~e~I ~ll~l'"~i~6ii~'cl" 'i t'~'fi""'~O" '~'~" 't~t" 'ii~;'~ ii ........... .......... (~..l~tal...ex~e.p~t,~n...~l,a~gle~) ..................................................................................... at premises located at i,ltt.t~..~..~:...l~ewslz~'c/].]~'" 1t!~ ......................................................... ~ ...... ............................................................... ~ ' '~11~I'~'1~ ....................................................................... pursuont to op~li¢~tion doted ............................. ~'1~.~ ....... ~'~ ........... 19~...., ond opproved by the Building Inspector Fee ~ee...~..2..(~. pd to Bd/A~pls. oui~ain9 nsjYe~tor ~k TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 19 ........ Permit No. D,sapproved a/c ...................... ~,.,~...,..x ...... .j,,, 5~~ ................. ................ ...... ......... .............. (Bu~[dm~ Inspector) App, cat,on ........... Sign APPLiCATiON FOR I~if~I~I~[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 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 whote 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 far 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 o1: buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. ...lir~..t~./'alk..Shilv,'Z.a~d...]~rzc .................................... (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, ~essee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..................................... O~m~z..~f...ai~t ............................................................................................................................. Name of owner of premises ..... Es. tate...of...J.,.B,Ro, achs. ............................................................................ , ................. If applicgnt is, a/~z~rporate~ignat,~f~ of/duly authorized officer. ........ .... .,, ................... L:../. ...... (Name and title of corpoFate officer) 1. Location of land on which proposed work will be done. Map No: ........ ~ .......................... Lot No: ~ .......... Street and Number l~/,.~..~le~/...,~ .~tf.~.o.l~..~l..&..l~l/~..l~ail, i..[tt; ....... .l~e~..~.~£O].k ....................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy oF proposed construction: a. Existing use and occupancy ...~.~,.~.al'Ll~..~d ...................................................................................................... b. Intended use and occupancy ..... :D.$~..~-.(L~.,~.O~,~...~.:~ ..................................................................................... 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .................... Removal .................... Demolition .................... Other Work (Describe) ...]).~.~.~O~.~O~1~,], 4~ Estimated Cost ............................................................ Fee ...~,O~...]pe~,...Bq...~[l~¢ ....................................................... (to be pa~d on filing this application) 5. If dwelling, number of dwelling units .............................. Number of dwelling units on each floor ............................ If garage, number of cars .............................. i .............. : ............................................................................................... & If business, commercial or 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 ........................................ B. Dimensions of entire new construction: Front ................................ Rear ............................ Depth ............................ Height ............................ Number of Stories .................................. 9. Size of lot: Front ................................ Rear ............................ Depth ........................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ........ .~I,.¥...ft~S.t~.~.¢~. ........................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ...... 13. Name of Owner of premises ........................................ Address ............................................ Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contradar .............. i ..................................... Address ............................................ Phone Na ..................... PLOT DIAGRAM Locate clearly and distinctly o1~ buildings, whether ex~sting or proposed, and indicate al~ 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. STATE OF NEW YOP, J<~, ) COUNTY OF .~.f..f,~ ............ ) S,S. ............ ~.N'$~[.~..~.~..~/~][~ ................................................... being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ?1mi P~'~I~.~I®I~, (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 fi~e this application; that ali statements contained in this application are true to the best of his knowledge and belief; and that the work wi]l be perfor~i~the ~e~set forth in the application filed therewith. Sworn to before me this -~' ' ~ ....' ~ '~ ' / ,~ /z/ . ~ -'// ~ ~ ~ I{es~d~ ~r, ':~f~,< County - /Z ~ /// ~ ~ / ~: ,. ~'~)-Z-~ >: /, , ....... ~<..c~,~.,~;.,:~.;~t~ ...... ~.~.,_~;; ................................. Notory Pub ~c~:~,~Y,.~:.~ .................. County (Signet~re of epplicont)