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Home My WebLink About2770-zApproved z .~ 19 Permit No ......Disapproved a/c ~~-~ ..................................................................... APPLICATION FOR BUILDING PEP. MI* la//--'3 "-L~O ~ 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 propertymust 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 applicaht. Such permit shall be kept on the premmes available for inspection throughout the progress of the work. ~' '~- e. No building shall be occupied or used in whole or in part 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 ~ Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Regulations, for the con'ruction of buildings, additions or alterations, or for removal or demolition, as herein described; The applicant agrees to comply with all applicable laws, ordinances, building code and regulations. (Signature of applicant, or name, if a coqx~rotion) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. l~archaser under contract Nome of owner of premises R~=$.ter. lln&.F~a~a~ ........................................................................................ 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: ...... J~ ...................... Lof No: ~ ......... .~ Street and Number 'lil/~....~qollrls['..A~.e.~......t~a.t:l;l,.l;;~l~.....~.,.~., .......................................... ~'1' ~ ~ /~ 3 ~f~ ::~ Municipality 2. State existing use and occupancy of premmes and intended use and occupancy of proposed construction: a. Existing use and occupancy ....... .~..8,~.~L~.~..,~C~.~. .................................... b. Intended use and occupancy ..... ~..~'nm~.~.Z..~¢~,~,~,,1~'~ .................................................... 3. Nature of work (check which applicable): New Building ~ ..... Addition .................. Alteration ....... : .......... ~/~..air .................... Removal .................... Demolition .................... Other Work (Describe) ...................................... Estimated Cost ............................................................ Fee ~,J~K) ........................................................................... ~ (to be paid on filing this application) 5. If dwe ing, number of dwelling units .......... GD.~ .......... ;Number of dwelling units on each floor ............................ If garag~e, number of cars ........ D.{}~ ......................................................................................................................... 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 ..~.0./.. .................. Height ............................ Number of Stories ...O~e .................. with 300 sq. f~; 1~iD~ 9. Size of lot: Front .......~..br,.~..~.~.~{... Rear ....:~.~. ................. Depth .......3.....(~.../....3...3:~. ......... ..................... ,.. ' 10. Date of Purchase ........................................................ Name of Former Owner li Estate 11. Zone or use district in which premises are situated.,.~.....~.....~......~.~l.§.~. .......................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation:? ............. ~1~ ........ ; ............................ 13. Name of Owner Of premises ~..~.~.~...~..~?..~.e.~..a..~..c]..Address ......... .,,~,,,t..~.~.t..,~,.O,~ ............. Perone No .................. Name of Architect ...................................................... Address ............................................ Phone No..................... Name of Contractor ..... ~a~e ...................................... Address ............................................ Pf~ne No ..................... PLOT Locate ,clearly and distinctly all buildlr property lines. ~ive street and block whether interior or corner lot. ' and indicate all ~etdaack dlmmnM~ from and show ~treet names an~ indicate STATE OF NEW YORK. ) COUNTY OF ....... IS tJ:o.q.k. ...... I Is. ............. ,..~.e:be~,..,~t.,~.l~lc-l.~:K1, ......... : ........................ being duly sworn, deposes and, ~ays that he is the applicant (Nai~e of individual s gn ng app cotibn) ' above named~ He is the ........ ]~]3,T..~,llI~I.e~'...LI~.~....~.(~,.~:~.~.~. ....................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform, o~ have, performed the ~aid work and to make and file this application; that all statements .c, ontained in this a.pph.cation, a~e t.m.e to t,h.e. ~ of ..h. ls knowledge and belief; and that the work will be performed in the manner set torth in the.opp.cation rlle~ tnerewlm. .S.~._.m to bpfore me this ,._ ..... day of ......... '""'../',,~X~,~....., - ....... Notary. Public, ~~ ......... TOWN OF SOUTHOLD 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? 2770 z Permission is hereby granted to: ......... S~und..~ve ................................................ ....... ~..~on..~..m~e..~O..aq..:t..~ea) ...................................................................... ~t premises located at ....~..8G~..~V~ .......................................................................................... pursuant to application dated ....A~.l~....~..~..~..~ ...... 19..~., and approved by the Building Inspector. N~ Rot to be .loser th~ 2~t to North (Reeve) line or .loser than 10 ft ~ east or ~est 11ne~ a~ o~ Buildin~ Inspector [