HomeMy WebLinkAbout2293-z ' FOEM NO. ~
-- '~'~T0WN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y~
BUILDING pERMiY · , ' '
(THIS PERMIT MUST BE KEPT' ON THE PREMISES UNTIL FULL
coMpLETION OF THE WORK AUTHORIZED)
2293
Permission is hereby granted to: '
................................. ' ........................... l~.t~.i.~,,lek. ......................... ~ .......................... ~....;....-..,...'. ...........
~ursuanf to application dated ............; ............. ~'t~l/, ....... ~{j.;..., 19..~1~., and,apprOVi~d by the
Buildin§ Inspector
TOWN OF SOUTHOLD
~UILD,NG DEPARTMENT
ouT
Exam,ned ........ ..........
Approved .....................
Disapproved a/c .,~..~Z,~,....,.(~..;...~%..~ ....... ~,..~:~. ...................
.......
(Building[Inspector)
Application No. ~._.~L ~.~
APPLICATION FOR BUiLD,NB PERMIT
D t $&nu~r7 15t 19 64
INSTRUCTIONS
o. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building
~nspector.
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 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 pa rt for any purpose whatever until a Certificate of Occupancy
shall hove 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 Lows, 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 regulations.
.............. .........................................
(Signature of appliconh 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 .... .(~,[.8...~., .1~..~.-~. ................................................
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: ............ ~O.17~. ....................... Lot No:
Municipality
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy .~5 ~¢~.~& 0~' VtlC&~J;
place to exerc&se &nd h~de. ' ..........................................
3. Nali, ure of work (check which applicable): New Buitding ..... ~( ........... Addition .................. Alteration .............
Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................
4. Esti~noted Cost ....... ~ ~ .~. ~....~...~ .0...0..,..0...0. ...................... Fee .....................................................................................
(to be paid on filing this application)
Not & dwelling
5 if dwelling, number of dwelling units .............................. Number o{ dwelling units on each floor ......................
If garage, number of cars ..... i ...................................................................... .............................................................
Not, & business '
6. If business, commercial or mixed occupancy, specify nature.and extent of each type or use ............................
7. Dimensions of existing structures, if any: 'Front ........ J,.~..,~'.lJ~.... Rear ...... J,.~...~...~ ...... Depth .i ....... :~.(I...~..~....
Height ...... (t..;J,ll,~ ........... Number of Stories ................. ,1, ..............................................................
Dimensions of same structure with alterations or 6dditions: Front .......~2._,(.t,, ........... Rear ...... J.!~...,,~.J[~ ......
Depth ......~l.4...~'.t~, ....... Height . ....... ~....~.'J;.,. ............ Number of Stories ....... ~ .............................
8. DiMensions of entire new construction: Front ............1.2..~.t ......... Rear ....... l.~.'..£.to. ...... Depth ....2.4..~1~.o ......
Height ...... .~...,,~.t~ .......... Number of Stories ......... ~, .......................
9. Siz~ of lot' Front t~l.0.O. ~..'[:, Rear ~.00 .~. Depth ~.~00
~ ..................................................................... It~'~'[~'"~
10. Datb of Purchase ...~,p.l:'.~,l.. irk(l:.,. ~.q..-~.fL Name of Former Owner . .~.~.!I~'.~Z..~.i~i~...I!.~.~.I)..I!. ..........
11. Zone or use district in which premises are situated ............... P~ISI~,~t~.P, II.~...~....(.~....~.III~,.~.tI.Y..tI,) .......................
12. Doe's proposed construction violate any zon ng aw, ordinanc, e,,g,r r~gqlation;
~ ti ,r nd~r~_'~'e; ..................
13. Nome of Owner of premises .,..O~.is...(L...P.ike ....... Address .~]~.e~.~A~,.._.,..o ....... Phone NoPl~.7..~233,
Name of Architect ...................................................... Address ............................................ Phone No .................
Na~ne of Contractor .................................................... Address ............................................ Phone No .................
PLOT DIAGRA.M
I_ocat~ clearly ond distinctly all buildings, whether existing or proposed, and indicote all set-back dimensions fn
property lines, Give Street and block numbers or description occording to deed, ond show street nomes and indic~
whether interiororcorner lot. ~. , ~)%
STATE OF NEW YORK, )
COUNTY ;OF .~.II~.~.CI~I[ ......... ) S.S.
. O~IS G,. Pill[Ii , being duly sworn, deposes and says that he is the applicc
(tName of ndividual s gn ng appl cation) '
above named. He is the ................................................ ll~.ll.ll.t .........................................................................................
i (Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and t
this applic'ation; that all statements contained in this application are true to the best of his knowledge and bell
and that the work will be performed in the manner set forth in the application filed therewith.
Sworn to ~efore me this . /~2~/) /0~, ~f~/j~b'
· B2,da 0.. ...... ; ........ ; ...... ::. ........................