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Home My WebLink About3539-z POl?~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? ~39 Z Date ........................ ..~..~ ...... ..~.~ ......... , 19.,.~.~.... Permissi~ is hereby granted to: ~ ~ ~ ~ / . ........... .....~z~..../:~,~x ....................................... ......... ................................................. at~remises I~ated~'~ P~IV~O 1~o~ t ~2fatt ~c~ ~o~f,o~ ~ ..[ ........ ~ ................... :.,'....:...~~..-.~.~., ............................... : .......... : ............. 2.,...::..,.: pursuit to opplicOtipp dmod ........................... .¢~ ....... J~., ......... , 1~,~....~ Ond: oppmv~ by tho~ e ~.;....: ................. ~ FORM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLrRK'S SOUTHOI. D, N. Y. Examined .. - Approved ..[...~.~......!....~.. ........ , 19.~..]. Permit No..~......?....':~....?. ~..~. ............... ....... Application No. :.~.......~...~..?...~ APPLICATION FOR BUILDING PERMIT ate .................. ......... ./..7 ......... 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 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 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, build,,L~ code and regulations. .................. ...... ...................................... (Signatur~of applicant, or name,~i.~ o corporation) ....... .......... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engi'neer, general contractor, electrician, plumber or builder. ............................................. .............................................................................................................................. Name of owner of premises ..................................................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) /'~' Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ........... ~.~J.~.~.~.~...~..~. ................................................................................ b. Intended use and occupancy ~.~]~ property I whether in 3. Naiure of work (check which applicable): New Building .................. Addition .................. Alteration ReRair .................. Removal .................. Demolition .................. Other Work (Describe) 4. Estimated Cost ............... ¢ ........................................... Fee ....... (to be paid on filing this application) 5. If al, welling, number of dwelling units .............. ..O.. .......... Number of dwelling units on each floor If ~arage, number of cars ................ ~. ......... 6. If usiness, commercial or mixed occupancy, specify nature and extent of each type of use 7. Dir~ensions of existing structures, Jf any: Front ............................ Rear ................................ Depth Height , Number of Stories Dimensions oF same structure with a,lterations or additions: Front ....................................Rear Depth .....~ ............... Height ............................ Number of Stories ....... .~.. ..................... 8. Dir~ensions of e, ntire new construction: Front ........ ;......~....~....~ ........... Rear ........ ~....."~ ....... Depth ..... ....~....,~.. Hei]ght ....... ,/..~..~..~... N.u. mber of ,S~ories .............. ( .................................................................................... 9. Siz~ of Io': ~......~....~../..~......~,R~. .................................... Bepth_ ................. ~...;.:...~ ...... 10.~¢¢~aa~e of Purchase ...........~1~'...~.~ ......... /..~..I./...O. ................ Name of Former Owner ......f~...~x../..~.!..~. ....... 11. Zone or use district in which premises are situated 12. Do~s proposed construction violate any zoning law, ordinance or regulation? ..~...~. 13. Name of Owner of premises .....~,.,,~..~...M.../~.. ....... !.~.~./..,~......Address ....~...~...~...~..~i...J~.~.l~.~...~. ..... Phone N Na~ne of Architect ...................................................... Address ............................................ Phone No. Nabe of Contractor ........ Address ~.'~/.~l......~.r.~.., .~...'~.¢~lCPhone No. ' PLOT DIAGRAM Locat~e clearly and distinctly all buildings, whether existing or proposed, and indicate oil set-back dimensions nes. Give street and block number or description according to deed, and show street names and bettor or corner lot. STATE O~ NEW Y~,~¢ ¢~ ~SS COUNTY, OF ,,.~~%.~ ' ' ' ' ................ ~ ................ ~ .............................................................. being duly sworn, deposes and says that he is the applk (Name of individual sign~ application) ,. ,s,he ............ ...... : ......................................................... above nQi ned. (Contractor, agent, corporate officer, etc.) of said o, mer or owners, and is duly authorized to perform or have performed the said work and to ~ke and this appli :atio~; that all statements contained in this application are true to the best of his knowledge and belief; that the, ark will ~e performed in the manner set forth in the application filed therewith. Sworn to Before me this Notary Pqblic, (Signature fiicant) 6, State 0f No, 52-0618t~ ~uii~ gommJssio~ Expires M]I~