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Home My WebLink About2240-z FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ........ ~i....??. ...... , 19....~.... Approved ........................................ , 19 ........ Permit No .............................. Disapproved a/c ..~~.~..~.~:~.L...~:...~__~ ................................ i'l~';'i'l~i'~'~'/; ;'~';~r; ;i ............................ Application No...~.~..~. ........... 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 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 o 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 o Certificate of Occupancy shall hove been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment 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 re~lulations. (Address of applicant) State whether applicant is owner, tessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ......~...~....~..'¢ /q ~' ....... ....~....' ......./O/~-'"'"'""'""~-.~.~'~ "'""~" ~'""'".~...~.'"~'" If applicant is a corporate, signoturb[of duly authorized officer. ~/'~' .... (Name and title of corporate officer) Locatonof and on wh ch proposed work w bedone Mo No' ~L. ~ ~ ~:~q~}-o' ixl ~-/O-ll Street and Number...~....~...~.......~.....~....~.f:~.~ .................. ~~....~ .............................. Municipality 2 State existing use and occupancy of premises and intended use and occupancy of proposed construction: FOlt~J[ NO. ~ 'r0WN 0F S01J?HOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KI~PT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N-° 22 0 z Permission is hereby granted to: ..... .~ ~.e. ~,.~:... ~.e..~....a....~. .................. ...... ~..~..~.~.v.~ .......................................... ...... ~.,V.~.~,,...~..e~.....~.o.~ .............................. to ..... :~,l.d.. ae~..o,u ~...~,~m ~t~...ct~.~:~O.,~gr ................................................................................. et premises located at ,...~../..~.~..~..~.~..~.~.~.`..~...~..~.~..~..~..~:~.`.~..~.~..~.~.~..~.`..~..Y~....~`~ ........................................ .......................... X~o.~../~.o.~...9.,...~,.o.~...~.~,...~._T~ ~.~ora ;~L~....g.9., ... pursuant to application dated ............................ ~..O~....e.~.~....6.. ......... 19.....6..3., and approved by the Building Inspector Fee $....;t,..Q~,. ~0 ........ 3. Nature of work (check which applicable): New Building ._...~.....~'.... Addition .................. Alteration .................. Repair .................... Removal .................... Demolition ........... ~ ...... Other Work (Describe) ........................ / ~-~~ -~ .~ 4. Estimated Cost ....,.....:.,/....~..u..O. .................. Fee .. ................................................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ........... d~....Number of dwelling units on each floor ............................ If garage, number of cars ................. ~...k~..~..! .................................................................................................... 6. 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 ........................................ 8. Dimensions of entire new construction: Front ........ ~...~...-....Z~... ......... Rear ...... ~...~...~;....~.. ...... Depth ....~.....?..~..~. .......... Height ............................ Number of Stories....~ ........... 9. Size of lot: Front ......... ..O. ................ Rear /' ~-c) Depth //'.x~'.../....../.O 0 ............. .......................... Nom:, f 10. Date of Purchase 1 1. Zone or use district n wh ch prem ses ore s tuated .../~... ~ ................................................ 12. Does proposed construction violate~a:ny zoning law, ordinance or regulation? ............ ./...J~ .............................. 13. Name of Owner of premises ~, ~-~ .~..~.. Address~.~)--C~b0~_, ,.~_~.~}J(~-7-,, ' Name of Architect .....j~j.....~_~, ~.~.~.~.~ ..................... Address ................ .~ ......................... ~'hone No ..................... Name of Contractor .,~..~Z..~ ....................... Address ~ 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 according to deed, and show street names and indicate whether interior or corner lot. adore named. He is the ........... 'L..~,.,...?...~,_~...w.,£..~ ....... ~~.; ............................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, end is duly authorized to Perform or have performed the said work and to make and file this (~pplication; that all statements contained[q~isB~li~on are true to the best of his knowledge and belief; and that the work will be performed in fhe m~' ~[~[~f°~n~ [~ application filed therewith. Sworn to before me this ~ / c~mm~i0n ~pir~s March 30~ 19~ ..............................¢ ....... ......................... Yl//l NotaF Public, . ..... ~'~'~ ......................... o (~ig~ature of appli nt)