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Home My WebLink About1858-z FORM NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.o 1858 z Date ................ gl;l:~l~ .......... ~' ............. 19'"6~' Permission is ~ereby granted to: ~a~e~" '~'~"" ~C~"" 'J~)c' ~ta~'~ ...... ................... ~1; ~'J:~tt'~it' ....................................... to -'"~ff.l~" ~c~" '~t~'dIl:~n'"dtt" 'iii~'' 'ii'~t'~'~ti~'' 'kl'&ii~II~ ...................................................... at premises located at ...tl~fg.....Sotltld...~.-~.e ........................................................................................ ................................................. ~:~:It~Z'~ ~'"'"~ ~'Y; .......................................................................... pursuant to application dated ........................... ~llg11$t' ....... 22 .......... 19..~2., and approved by the Building Inspector Fee $.~,eO ............. ~ NO. ! TOWN OF SOUTHOLD BUILDING DEPART/~ENT TO~,¥N CLERK'S OFFICE SOUTHOLD, N. Y. Exomined ............................ ' Approved ............................ .t...L. ....... , 19../......Permit No. ..~.....~.. ........ Disapproved a/c~ ...................... ~ Application No. · APP|.ICATION FOR BUILDING PER/~iT Date .......................................... ~ ,~Z- 19 ~'~' 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 applica- tion. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon epproval 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 H,EREB¥ 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, alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances an~ regulations. ........... ............................... (Signature o~applicant, or name, if a corporation) (~/ ~' (Address of applicant) J State whether applicant is owr~r, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ................tJ~..~....~.. ......... ..~...T./~.....~./~.~.. .................................................................................. 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.: ........................................ Lot No.: ...................... Street and Number .............~.....~..~...t .......................... ~ .............................................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction. o. [:xisting use ond occupancy ......... ~ ................................................... b. Intended use ond occupancy ......... ~¢'.~. ...;~ ....... ~"~' ........................................ / 3. Nature of work (check which applicable): New Building .................... Addition ....l~....... ..... Alteration .................. Repair .................. P, er~eva] .:&. .............. Demolition .................. Ot,h~er Work (Describe) ................. (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 occupa.ncy, specify nature ~:nd extent of each type of use ............................. D,mens,ons of same structure with alteration~ or a,,dditions: Front .. ~..~, .,~..: Rear ~.,.~.- Depth ......... ......r~'7... .......... ........ Number of Star es ........~/. ....... 8. Dimensions of entire new construction: Front .............. L~..~..:.. Rear ............... ~.~....~t';..Depth ...... ..'~......~..~.~...". ...... 10. Dote of Purchase .......................................................... Ne.m~ of Former Owner ........................................................ 11. Zone or use district in which premises are situated ........ ~......,~.~.*/~..i(~.t-~?.~r~... ......................................................... 12. Does proposed construction viol,ate any zonin¢~ ]aw, ordinance or reaulotion? ............. .~.~(.C ........ ~ ......................... Name of Architect ...; ...................... ~. ...................... Address ................................................ Phone No ................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block numbers or description a:ccording to deed, and show street names and indicate whether interior or corner lot. · STATE OF NEW_/'~01~1~;,. ,, ~) ) COUNTY OF ~...) ~.~. ...................................... being duly sworn deposes and says thor he is the app [cent (Name oilYinaiv'~luol signing qpplication) above named· H~ is the ............/~...~~ ..................................................................... (Contractor, agent, corporate office'~"~r'~ii ............................. of said owner or owners, and is duly authorized to perform or have perforn~ed the said work and to make and file this application; that all statements contained, in this application are true to the best of his knowledge and ballet; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this , .......... ....... day of L/ t~tary Public, State of ~ew Ynrk