The URL can be used to link to this page

Home My WebLink About2619-zFOI~M ~0. I TOWN OF SOUTHOLD I}UILDING DEPARTMENT TOWN CLERKfS OFFICE SOUTHOLD, N. Y. Examined .../. ................................... , Approved ....~....~T[..........~..i/ ........ , 19..(..~:'ermit No..4~...~....t.?.......~... ..... ........... .... · ............................................. APPLICATION FOR BUILDING PE~IT INSTRUCTIONS o. 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 a Building Permit to the applicant. Su~ch 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 o Certificate of Occupancy shall have been granted by tl~e Buildin~L Inspegtor ~. ~'~-~,*..~..~- ,4, PPLICATION IS HEREBY t~AADE to the Building Deportment for the i'~ance of a.J~uil~jc~..P~r~nit pursuant to the Bu Id ng Zone Ordinance of the Town of Southold, Suffolk County, New York, an~ other apphcable Laws, ~Drdinance~ or Regulations, for the construction of buildings, additions/Of~]~rations, or for r~n~oval or demolition, as herein descril~'ed. The applicant agrees to comply with all applicable ~ grazed re~on(~,,,, Add ess of ap ica~L . 240-e4 We].~'er AVe., State whether applicant is owner, lessee, o~t;'"~rc~ct,~'~g~'~n'ee~r, ~e~e;'al '~:ontractor, electrician, plumber or builder. ..... : ................................... Y& .......................... i ............... ........................................ ........ ............. ~...;[,... ~..L~r.e.~.~.~.. ~,.. ~l~r~A ~ N~ne of owner of premises ....... ..................................................... ' ................... 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. Mop No: ............. .g..0. .......................... Lot No: ,O..~...~.~. ........ Street and Number 0.11]k"wo~d D~.iY.~ (].~.¢1,&~ B~ ~.~ ~.~.~,...~.~...~. ..... ~ . Municipoli~ State existing use and ~cuponcy of premises and intended use and ~cuponcy of proposed construction:~ a. Existing use and occupancy b. Intended use and occupancy 1 ;FrailS,: residence and accessory uldg ......... ....... ......................................................................................................... ...: FOR~][ NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TO~VN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 2619 Z Permission is hereby granted to: ~ttena a~.. J. ,... ~._~, .i,4.. &..Wi ~'e .......................... ...~..,,,... ~t~....We.l. tm,,..A, ve. ............................ · .ttese~l~.~..-.~ ..... ~-.~ ............................... to .. {~...&..~e~. eme..~ms..~.. ~re~ .Z.Jkn~.... ~h.. te~e rs m-~..b'~ .1~ ir~ ........................ ct prem,ses located at ..~.etr....~J~jF.4~h~,..~h ..j~,]l~..{~v~.p..~O} ...................................... .................................... i~kesl~e..& .~o~..~rivet ................................................................ .................................................. B~4~hol~1~ ..... /~.Z. ........................................................................... . . [aS eorredte~-on pursuant to application aoTea'. ............................ ll~l)~......e.~.., I~'~', and approved by the Building Inspector I ]J~t~eI ~el'l~l~lt, ~ssl~e~ sLlb~eel~ to eorre=t loe&~;ion o£ the ~ccessory bu/ldtn~ Fee $.~).~ ........... ..... ' · ,.~...~. ..... :..~C'" ......... ~._,....:,.,:,:~..f...~.:.~/." --'_ ........ ' ' Building Inspector ! i~OTEa Contract of sa1® document enclosed herewith 10. 11. 12. 13. Nature of work (check which applicable): New Building ...... ,][,~ ....... Addition .................. AlteratiOn .................. ( Describe) ~~. ~;~J~ Repair .................... Removal .................... Demolition ........... ...,~.... ~r Work . Estimated Cost ...... ~], §+O.O.D...O.O. ............................. Fee .............. ~ .~J.~. ........................ :. ............... : .................. . (to be paid on filing this opplicat on) If dwelling, number of dwelling units .............................. Number of dwelling units on each floor ............................ If garage, number of cars ...................... JJ'.OJ~.~ .............................................................................................................. If business, commercial or mixed occupancy, specify nature and extent of each type of use ................................ Dimensions of existing structures, if any: Front .......... .-.z. ............ Rear ........ =: ............... Depth ......,:: ..................... Height ............... .-:. ........... Number of Stories ............................................................................................................. Dimensions of same structure with alterations or additions: Front ............................. Rear ..... = ......................... Depth .............. ~. ......... Heiaht ............. :=:: .............. Number of Stories ..... ~ ............... ~< .............. ~ ' Dimensions of entire~j~e~construction: Front ...... .~...~....~....~. ........... Rear ........... . .~....~...~..... Depth ........~..t,. ............ Height ............................ Number of Stories ............... ~. .............. Size of lot: Front ....:..i~l~.~J~r;~..~ ..... Rear ..:~~ ...... Depth ....(ZJBO..~L ............. Date of Purchase '....~~ ...... ./2~..~....~.~...~Nome of Former Owner~--~'~'"":' Zone or use d str ct in which ~rem ses are s tuated ....~....~...~..~.~.~.~.... ........ Does proposed construct on vieJ~ any zor)ng aw, ordnance or regulation~ Name of Owner of premis~l~.,~~...Address .ll.~.~n.~J~ Phone No. ~I~...~' Name of Architect ...................................................... Address ...~-~. ....... 7....~. Phone No ..................... Name of Contractor .................................................... 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 according to deed, and show street names and indicate whether JnteHoror comer lot. S.~k_ TE ~ NEW YORK ) ~S / ,~ .~."~.~'q) ~'''-, ,. ~'~- ~~ --~ a~m..-~[~ ~ ~N0me ~f individual signing app~i~?~p~ · .... .... ~d. He is the .. ....... :...: .......... .:'::.Z ............. : ......... ~ne[ or Owne~; and is duly authorized to perform~e~ormed the said work and to make and file ~l~ation; that oll statements contained in this pp~cati~ tEue t~the be~f his knowle~e and belief; ~ t~]he work ~erformed. in .the manner set~o~ appl,icgti~e~i~.