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Home My WebLink About2685-z FOI~I~I 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? 2685 z Permission is hereby granted to: . -~lm~.t, .Wad~t~ .................. ........... ~h~r~..~l~n~ .................................. to ........ ~l~..an..~t~.o~...~a..~...~.~.~ma..~.~.?.~.....~...%.l.~.i...n~ .......................... at premises located at ...... ~/f'~....Mh~fltle~- .JJ,~® ....................................................................... ............................................. ~r~..X~ ...... ~i~I~ .......................................................... pursuant to apphcation doted ............................... ..J~.Ch ...... 31 ...... 19.....6~' and approved by the Building Inspector Fee $ ..... ~4.00. ......... FORM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , ]9 ........ Permit No ................................. Application N o.'~......~....~...~ ~ .......... Disapproved a/~ ................................... /,,.i (Billdln I '" ....................... ................................. 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 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 have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the iss/ue/nce of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New Yo, pl~,/an~ other?pplico~le)_aws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or[or/ten, raj o~'der)~ol~o~, as ~erein described. The applicant agrees to comply with oil applicable laws, ordinances~~~~.:~~~~ .... (S[Z~~~: ~[ ~ corporation) .................... ~ .......................~.~. z .~..4. ~...... ~. ~. ~ .~. ~ .~'. F J (Address of applicant) State whether applicant is owner, llessee, ag.~nt, a~itect, engineer, general contractor, electrician, plumber or builder. I If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposefl work wil~,be done. Map ~o: ......... ~...~ ......................... Lot No: ................ Street ond Number .'.~.....b.?'~..~..(..~....~......~....~...~..A...~.,~.~..~.~.......~..' ./~ ~ ~ Z .......... · .. .C.. ../7. ~. : .......... Municipality 2. State existing use and occupancy of premises and intended use and occupancy oJ proposed construction: a. Existing use and occupancy ..... .~.....~..[.~:..~..~.....~.~..~..~.. ~:~...~....~...~.,¢~..~ 3. Nature of work (check which applicable): New Building .................. Addition / Alteration Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................ (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 .....~.ff~../..~.~....~'.,..~..~..... 7. Dimensions of existing structures, if any: Front ........... 2.~.. ........ Rear ....... .~......~. .......... Depth ....... (...,~....0 ............ Height ......... L~..:..~.: ..... Number of Stories ...........g...~...?~-. .................................................................................... Dimensions of same structure with alterations 9r additions: Front ............. ..~..~./~ ......... Rear ....... ..~.....~.. .... Depth ......!...L.~...~. ............ Height ........... ./.4...~.~..~.'. ....... Number of Stories ...........~..../?...~--T.. ................... ' ........... 8. Dimensions of entire new construction' Front ~2,~ .~. Rear ........... .~....~. ...... Depth 11. Zone or use district in which premises are situated .......... .~...U....~..!.l.?..?.....~....~. ............................................................ 12. Does proposed construction v~91gte ~ny zo0i~g ~aw,t~rdinance or reflulation? ........ .~..C~ .................................... Name of Contractor ..... ......... Phone 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 des~riptio~ according to deed, and show street names and indicate STATE OF NEW YORK, ) ~ ~ COUNTY OF ............................ ) b'?' · .. .~ J.Q. ,~....~::~ ................................ be,rig d.uly sworn, deposes and says that he .s the apphcant (Name of indiwl]ual signing application) ~ (Contractor,,~'e~nt, corporate officer, etc~) of said owner or owners, and is duly authorized to perform or have ~erfg'rr~d the/said wo,~, aT~ to make and file this application; that all statements contained in this application ar~tr,~e/t/o the/ t,~f,Y~is/4A/nowledge and belief; and that the work will be performed in the manner set forth in the/f~JSF)ti96t,/on fil,~d Sworn to before me this ......... -,~ ~ /W,f / / / Z/.// // Notary Public ....... .~.~ ............ ICounty Y (Sign~ ~'of applicant) L~ .30 '?- TO ~E~T WADDINGTOIV df