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Home My WebLink About2664-z FOItM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. [xamined .....~....~.... !~_..., ........................................ , 19 ........ Permit No ............................. ............................. ~'e~;;;i ................................ APPLICATION FOR BUILDING PERMIT ate ....... !..! ................... ...... 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 a detailed description of layout of property must be drown on the diagram which is port 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 o 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 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 taws, ordipc/nces end regular!ans. // ~(~ ~,. , '~.~ IA, ,' L f.' ,(Signatureofapplicant, o:na~me, ifac, orporotion) ..... ..~.~t,.~..:.V.~., ...~.~. ~,-,.. ........ : ............... °f State whether applicant is owner, lessee, agent,,_.architect, engineer, general contractor, electrician, plumber or builder. ............................................... ......................................... . ....... Name of owner of premises ....'~..~.~ ........ ~..~-~..~ F ..~...~..~,~ ~L ......... If applicant is a corporate, signature of duly authorized officer. (Nome and title of corporate officer) 1. Location of land on which proposed work will be done. Map No: ............................................ Lot No: .................... Street ond Number .............................................................................. ~.. ...... .~.......: ................................... Municipality 2 State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................................................................................................................................... b. I ntended use and occupancy .. 1.~,..~..... ~.~.~...~..~...!..g.~ .~-~ ............................... 3. Nature of work (check whtch applicable): New Building ...~ ......... Addition .................. Alteration .................. Repair .............. ..~. RemoC, all~ .................... Demolition .......... ~ ......Other Work (Describe) ....................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ........ J .................... 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 ................................ ~lumber of Stories ............. 8. Dimensions o_~fegtire new construction: Front ....... ~.~2. ................ Rear .....:2~../~ .............. Depth ....~..~../Z. ............... .. Height ...... ''~ ................. Nu~nber of Stories ...... 1 ........................... 10. Date of Purchase ........................................................ Name of Former Owner .... '.~.~....~...!-~.'~..?:...' ............................... 11. Zone or use district in which premises are situated ................................................................................................. 12. Does proposed construction~..~.A~. ~/vi°late ~g.s~y zoning law, ordinances..,. _ --~°r regulation? .....~..~..:. ...................................... Nome of Architect ...................................................... Address ............................................ Phone No ..................... PLOT DIAGRA.M Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-b~ck dimensions from property lines. Give street and block numbers or description acc?ding to deed, and show street names and indicate whether interior or corner lot. I~f~. kl STATE OF NEW Y~R~ ~Z ) ~ ~ COUNTY OF ..~....) b'b' (Name of individual %g.n.'~~on) above named. He is the ..... : ..: ......................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner, or owners, and is duly autho~ll~l~i¢. Pet "~¢~rr~r~°r have performed the said' work. and to make and .file this application; that all statements c~tt~¢~i~t.,i~,~/~0~el~[~a,t&on are true to the best~ of h,s knowledge and bel,ef; and that the work will be performed i,n..!~,,h..(i.~c~l"~-ii~t¢~t~'~t~ the application filed th/~)'ewith. Sworn to befpre me this ............ ~ I ~ /~, [I .......... .//./..~. dayof ................ ~~., 19.~:Jl~__/00 , ,, (~, ¢~->' .~ ., , /] .~,~-~i//,,f/^ //' .,.~n~,.,.~,.,..~.~..~.,.,--~,. ........ ,.~.~,!;~.,¢~-.,..~..;.~ ........................ Notary Publ,c, ..~.~..:..~.. C~n,~¢//_ ,~ (Signature of applicant) FO~M NO. 2 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? 2664 z Permission is hereby granted to: ~F~eO .~..~. ~,~.~.bl...:: ..~.... ..................................... ~..~...~ ~ ,~ fS~aA. ..... ~..e.~.e...~...p.~.~...T..: ............................ pursuant to application dated ............................................................ 19 .........and approved by the Budding Inspector Bulldmng Inspector