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Home My WebLink About1945-z FOI~M NO. 2 TOWN OF $OOTHOLD 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.° 1945 Z Date .................. ~/Ji~'lJ~.... · ~,O .......... 196~,.. Permission is hereby granted to: · l'Qhn.. Rro.~,m .......................................................... .... .H.t..ddle.. Road ................................................ .......... ~%~t.t~k ................................................. to M~ve ..a~ · · ezl.st~n~...dwe.l.t l. ng...re. · th~.s ...lo~a.t4.~u ....................................................... at premises located at ..rea~..crf..'l~t.~...~/~..~c~d'l~..~o~d....(C~,~.) ........................................ ~e,a~t.l. tuek.t.., t~,.¥., .................................................................................... pursuant to application dated .......................... ]~OV~'b~l*'""~:O ......... 1~...., and approved by the Building Inspector Fee $.~,0,,00 ........... ~-'r .......... Building Inspector TOWN OF $OUTHOLD BUILDING DEPARTMEhIT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ...~...''~' ~'b// ~ L'%'~ Approved ........................................ , 19 ........ Permit No .............................. Application No. / gl &/'? APPLICATION FOR BUILDING 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 o 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 TOy 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 po rt for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS H.EREBY 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 and regulations. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, arch[re:t, engineer, general contractor, electrician, pIumber or builder. Owner Name of owner of premises ...~O]~.~.Q~ ......................................................................................................................... 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...~t..'~.* ........................................................... Municipality ........ State existing use and occupancy of premises and intended use and occupancy of proposed construction. a. Existing use and occupancy .V...~..e.~,~.~ b. Intended use and occupancy ....DX~.~...,~.~.,'~,~...r,].'~e~,~;~Flg ............................................................................... 3. Nature of work (check which applicable): New Building .................... Add,ition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ..~O.~.e..,I1,11. 4. Estimated Cost ....~$..~'~0...~./~ .................................... Fee ....~, ................................ ~&~..~.~.....~. (to be paid on filin~ this application) 5. If dwelling, number of dwellin~ units ...... ~ .................. Number of dwelling units on each floor ............................ If garage, number of cars ............................................................................................................................................ 6. If business, commercial or mixed occupa.ncy, specify nature and extent of each type of use .................................... 7. Dimensions of existing structures, if any: Front ................. ~ ...... Rear ........ ~ ............... Depth ........ ~ ................ Height Namber of Stories ...... Dimensions of same structure with afferations or additions: Front ................................ Rear ................................ Depth ................................ Height ................................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .............................. Rear .............................. Depth .............................. Height .............................. Number of Stories .............................. 9. Size of lot: Front ....... ~.~.....: ............ Rear .............. .~ .............. Depth ..... ~ ................. 10. Date of Purchase ................ . .......................................... Na,m~ of Former Owner .......................... 1 1. Zone or use district in which ~premises are situated ...... ~....~.~ .......................................... 12. Does proposed construction violate any zoning law, ordinance or regu atJon? ................... ~ ...................................... 1 3. Name of Owner of premises~ ,....~...~ ........ Address ........ ~.~.~.~ .................. Phone No ................... Name of Architect ................. ~. .................................. Address ................................................ Phone No ................... Name of Contractor ...... ~.~_~ ............ Address ...... ~~ .................... Phone No .................. "'~ ~LOT DIAG~M Locote clearly and distinctly ~j buildings, whether existing or proposed, a'nd indicate all set-back dimensions from property lines. Give street and blo~[~ numbers or description .according to deed, and show street names and indicate wheher nteror or corner lot. ~ ~* ,, STATE OF NEW YORKM, ) c ~ COUNTY OF ....~'~ ....... ) ............................. ~...~ .......................................... being sworn, (Name of i~divi~al signing application) duly deposes and says that he is the applicant ~bove named. He is the ...,[ .......... ~ .... ~ (Contractor, agent, corporate officer, etc.) of sakJ owner or owners, ~nd is duly authorized to perform or have performed the said work and to make and file this application; that all stat~ment,s contained in this application are true to the best of h s know edge and belief; and that the work will be per~rmed in the manner set forth in the app/cation f ed therewith, Sworn to before me this ,f ................. dw of ............... ' / . ._ Notary Public ....~Z.~...~.~'.~,¥t,~. ~ .... ~te ol ~'~ork (Signature of applica'nt) ................ ~ / J No. 52-034496~, Suffolk Co~n~. ~ //f [ ~, Commission Expires March 30,