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Home My WebLink About2265-z FOl~l~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMrt (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 2265 z Permission is hereby granted to: pu'rsuant fo application dated ........................ L.....De~b~.?~ .... 19..(~].., and 'approved by the Building Inspector Building Inspector Ex.amined ............... .~..~..-.-I ........ 19.. . TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No..~...~.~,. ....... .~. ....... Approved ......................................... t c)..../....Permit No. Disapproved o/c ................ ................................... ............... .......................................... : ........... ........................ 7 ..... ;.~ ............................. · ................................. (Building I nspecto/) APPLICATION FOR BUILDING PERMIT Date ....~../.~¢ ...... ~ .............................. , 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 application. c. The work covered by this application may not be commenced before issuence 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 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 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, ordinences and regulations. (Signature of applicant, or name, if a corporation) ., .................. .............. ...................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........ ............................................................................................ Name of owner of premises ..... ./..L.L...~,/. ...... .~'..r,~..~.~,~-~,L.¢'.~.~..~.~:C,....~:L; ............................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Loc~tion of land on which proposed work will be done. Map No: ............................................Lot No: .................... Street and Number ...... ~'~'..~..~.-~.,.~,:~....:.~.~,~.¢.,d~'.......~;~:~:L..~ ....... Municipality 2, State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .(-]. b. Intended use and occupancy ................................................................................................................................. 3. No:lure of work (check which applicable): New Building .................. Addition ~' Alteration Rep. air .................... Removal .................... Demolition .................... Other Work (Describe) ........................ 4. Estimated Cost ............................................................ Fee (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 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 ......................... Rear ............................ Depth Hei~lht ............................ Number of Stories.....~ .......... 9. Size of lot: Front ................................ Rear ............................ Depth ........................................ 10. Date of Purchase ...-~ ................................................... Name of Former Owner ~ ~,~.;..~ 11. Zone or use districtI in which premises are situated 0,~,,t,~,~,~ 12. Does proposed construction violate a:ny zoning law, ordinance or regulation? ' 13. Name of Owner of premises .~..:...~..:..,'~/~-~...,m...~4...Address .....~.~. '~'~./~,~-¢~¢,.~......./..~.. ..... Phone Name of Architect ...................................................... Address ............................................ Phone No. Name of Contractor ....~:.-e....~........c:f....~:Ft~.-4.~.....Address ..::;~....¢x.J~..~:..~.......:~...?/... Phone No. '.~'/..~..~.;..~:.'! PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions property lines. Give street and block numbers or description according to deed, and show street names and whether interior or corner lot. STATE OF NEW,,~,O~I(,~/,,~., COUI',ITY ~DF ,~..!'~,~...C::::..':~.,......) ~'~' ................. ....M .............................~..~. .......................................... ~,,,y duly sworn, deposes and says that the (Name of individual ~n,i~plicati~) (Contractor, ~n~, cor~or~ officer, ~c,) o~ said own~'r or o~n~rs an6 i~ ~ulV ~u~Horized ~o ~r~or~ or h~v~ ~efform~d ~h~ s~id work ~nd ~o m~k~ ~nd ~hi~ a~li~ion~ ~h~ ~ work will be performed in the ~'~::~:~1~,t~,~ application filed therewith. and that the Sworn t~ ~,fore me this . __ ......................................... of Notary Pu.bhc, .f~A.. ................ :-. ................................... %~/c('/~ gnature apl