HomeMy WebLinkAbout3587-zTOWN OF $OUTHOLD
BUILDING DEPART~EHT
TOWN CLERK'S OFFICE
$OUTHOLD, N. Y.
3587 Z
"Perr~ission is hereby granted to:
to
· , , BUILDING . PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AuTHORIzED)
puts?Dr tO application dated ................... A1]~J~l~ ......... ~,B ............ , 19.~/..., and approved by the
Buildin~, Inspector.
Fee
'i'~OWN OF SGUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Approved '~ , 19 ........ Permit No. ~.~;.~.f4...~.~..~..~..
Application No. ~ > ~ ?
APPLICATION FOR BUILDING PERMIT
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 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 laws, ordinances, building code and regulations.
Fra~klin Born
(Signature of applicant, or name, if o corporation)
Mattituck
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
........................................ .....................................................................................
Name of owner of premises ..(~.~.~.b...O..Z:....~.Q ...........................................................................................................................
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.: .~.~.~...Z'...~.e..~..e..~.~...~.~:.. ..... Lot No~..~.~.. ....................
Street and Number ..... .r-J. erJ~z:..~t..t~est ......... 8e~¢}~0.18 ............................................................................
Municipality
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ..¥~.0...~..~..~....~.~.~.~. .......................................................................................................
b. Intended use and occupancy .....9.~.t.e....~.~.~.]:Z..~i¢:!?..]:..]:~ ...............................................................................
3. N~t~Jre of work (check which applicable): New Building ..~.... Addition .................. Alteration
Repair .................. Removal .................. Demolition .................. Other Work (Describe)
4.
~i (to be paid on filing this application)
5. If d~eHing, number of dwelling units ..... g~te ................ Number of dwelling units on each floor
If g~rage, number of cars
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use
7. Di~ ~nsions of existing structures, if any: Front ............................ Rear ................................ Depth
He ~ht ........................ Number of Stories
Dim ~nsions of same structure with alterations or additions: Front ....................................Rear
Del 'h ................................ Height ............................ Number of Stories ................................
8. Din ensions of entire new construction: Front ....... .~6 ........................ Rear ........ ~ ............... Depth ......... ~ .....
Heibht .................... Number of Stories ...... O~
9. Siz~ of lot: Front ............................ Rear .................................... Depth ................................
~0. Dat~ of Purchase ........................................................ Name of Former Owner
1 1. Zode or use district in which premises are situated
12. Doe~ proposed construction violate any zoning law, ordinance or regulation? .........
13. Na~e/of Owner of premises ..~JlO.~..~. .............. Address ...~.~.~e~ ................... Phone No.
Na~e of Architect ...................................................... Address ............................................ Phone No.
Na~e of Contractor ..a~b~..~ .......................... Address ...~,.~$.~ ................... Phone No.
PLOT DIAGRAM
kocat ~ clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions
property l nes. Give street and block number or description according to deed, and show street names and
whether i'n :erior or corner lot.
STATE OI NE~ YORK, I S S
COUNTY DF .~ .............. ~ ' '
~ . ~"" ' deposes ~nd soys that he is the opplk
~(Nome of individuol signin~ application) '
j (Contractor, ,agent, corporate officer, etc.)
of said o~ner or owners, and is duly authorized to perform or have performed t~e said work and to ~ke a.nd
this application; that all statements contained in this application are true to the, ~est 0f his knowledge and belief;
that the work will be performed in the manner set fo~h in the application filed therewith."
Sworn to ~efore me this