The URL can be used to link to this page

Home My WebLink About3149-zFORM NO. I B.U~LI)ING DF. fARTMIHT TOWN CLEB, K'S OFFICE SOUTHOLD, N. Y. APPLICATION FOR BUILDING PERMIT Date ............................. ,~.~1~.~... ~.(~ .......... , 19...66. .... 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 odjoini~.n~l'premises or public streets or areas, and giving a detailed description Of layout of property must be drawn on therdiagrom Wh~c~.~ part of this application. c. The work covered by this application may not be commenced before issuance of Buildin~PermJt. 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 part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. .A. PPLICATION IS HEREBY MADE to the Building Department for the issuance of a. Building Permit pursuant to the Budding Zone Ordinance of the Town of_Southold, Suffolk County, New York, qnd other applicable Laws, Ordinances or ~egulati,o. ns, for the constructi,on of bu![dJngs./a.dd, iti.ons or a!terations, or for removal or demolition, as herein desc~ bed ~ne applicant agrees to comply with a~ applicable laws, oraJnances, build ng code and regulations. ' ~ - - (Signature of applicant, or name, if a corporation) ........... G~.eenp~r.~. ,..11,~, .................................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician~, plumber or builder. ........................................................ ................................ ............................................. Name of owner of premises .....~o~te...tE.:J~ .......................................................................................................................... If applicant is a corporate, signature Of duly authorized officer. (Name and title of corporate officer) ~' ~ ~ " Location of land on which proposed work will be done. Map No.: ....... ~ .................... Lot No.: ...Z:~Z..; ......... ; Street and Number ..~.I~L~...I~r...~::Le.w..~T~S.....~I~,~OZ'.~;S...~,.~'~ . ...................... Municipality State existing use and occupancy of premiss and intended use and OCCupancy of proposed construction: a. Existing use and occupancy ........... Ta~a~..l_az~ ............................................................................................. b. Intended use and occupancy ........... g]~.~...~'.l~t~,~...~l~'~,~,~. ......................................................... L... ......... Nature of work (check which applicable): Now Building ..;~^ddition .................. Alteration 3. Repair .................. Removal .................. Demolition..,..;.; ........ ;. Other Work (Describe) ........................................ 4. Estimated Cost ........ 2t0~..~. ................. ~ ................ Fe~ ...... ~,~ ~).Q .................................................................. ; .... (~o be paid on filing this application) 5. If dwelling, number of dwelling units ........ .~.~t....~ ........ Number of dwelling units on each floor ...................... ~f 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 ........................ Numar of Storl~ ................................................................................................................. ~-~, .... Dimensions of same structure with alterations or additions: Front .................................... Rear~.~ .......................... Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ........... ~....~. ................. Rear ........ ~..~..~. .......... Depth ......~.~..~. ......... Height ...../...0...~. ....... Number of Stories ....... /. ............................................................................................................ 9. Size of lot: Front ............ ..~..-~....~ ........ Rear ................ ./..~..L..~ .......... Depth ...~..Z...O..~......,.~ ......... ~.~, ~ Date of Purchase .......... ..~...~..!...../..~..~.~. ........ N~ne of Former Owner ...~~~ 11. Zone or use district in which premises ara situated ..................................................................................................... 12. Does proposed cor~strnction violate any zoning law, ordinance or regulation? ............................................................ 13. Nome of Owner of premises ...~/.v..~..:..(:..~/.I.~...~...ql:~:'.[.Address i.'.'~c~,~er~N.fao'~ ........... Phone No, ~...°.:rT...".:Z.:..:I Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ...... ~/~. ..~.....G:......Address ......... ~ .................................. Phone No. // ..... PLOT DIAGRAM Locate clearly and distinct!y a, II ,buildi .r~p whet,her existing or pr. oposed, ~ indi?t.e oil set-back dimens!ons.from property lines. ~ive street aha mock numt>er or aescription accoraing to aeea, ana snow street names and indicate whether interior or comer lot. · ~.~ '~ AYg -I<--~'_--- ~ STATE OF NEW YORK, ~ [ ~S.S. L.LJUI~ I Y. .g~ ............................... ~ ' ' ................................................................................................. bein. g dulyswom, deposes and saya. that he is the applicant (Name of Indivtd~P_.l Signing bl~licafion) ' ' ' ' · above named. He is the ............................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform ~or have performed the aaid wo~k and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth'i~ fha ~;d'n:aflo~filed therowith. Swam to before me this ~ ,. , .....................~.-- day of ...... .~r~..;.....~ ............. , 1 9..4~ r~orory o c, ex~....~..^ .... ~ou ty ~ g re at cpp NOIAR¥ PUBLIC. ~o. $~-3255120 Suffol~ Count~ FOP~I NO, ~ 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? 3149 z Permission is hereby granted to: Wm~...~...~d.~..&..l~..~Lv~ ........................... .............. ~ ............ :..G.~ot~L~ ~r.~ ~ ...~.~y. ~...:: ....................... :.....:~ .......... ....... : .......................................... pursuant to app. cat,on dated, .,:.....: .......... ~'~I~.,....:R.~., .~.; 19~.., and approved bythe Building Inspector ....... L~.:~.. ~...... ~::.~:~:u:~.~ ............ : ...... Building Inspector~ ,/