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HomeMy WebLinkAbout3618-z FOR.1VI NO. 2: TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDIt4G PERNIIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne 3618 Z Permission is hereby granted to: .................. .~Lx.~..~.~...q~ .............................. to pursuant to application dated ............................ ~.~.~,.~..~...~...,' .]9..~,~.., and approved 'bY' the ,.., ,,,.. u~u~-Un-, ~, ,~ns-ec~or. · ~, ~ ,. ' ' t '~ ' °'i1"-' I r · Bu drag nspecter j~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ...................................... , 19 .... Approved ........................................ , 19 ........ Permit No ............................. Date September 11 19,...6.~. ..... INSTRUCTIONS a. This application must be completely fiJled in by typewriter or in ink and submitted in dupiicate 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 cornmenced 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 an 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 t° c°mply with all applicable laws, °rdi~]i ~id._ ~ii°ns' ( ' ~- me, if a corporation) New Suffolk ~ N.Y. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .....~.~..Z.~.~.e....~.~. ................................................................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: XXX Lot No.: ~ Street and Number .~.~Z..~.M~..~..~.~.~..~.~.~ ............ ~.~.$.~.~ .................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of propos~ construction: a. Existing use and occupancy ....... Y.~.~.~...~D~.~g ....................................................................................... b. Intended use and occupancy ............................ ~ .................~g~ ....... ~;&~E~ ....................................... / 3. Nat~bre of work (check which applicable): New Building .................. Addition .................. Alteration Repair .................. Removal .................. Demolition .................. Other Work (Describe) 4. Esti noted Cost ..~...~.~0~0..~./~ ............................... Fee ...... (to be paid on filing this application) 5. If welling, number of dwelling units ~.O...~..~1 ................... Number of dwelling units on each floor If aroge, number of cars 6. If )usiness, commercial or mixed occupancy, specify nature and extent of each type of use 7. Dir~ensions of e~isting structures, if any: Front ............................ Rear ................................ Depth Hei;~ht ........................ Number of Stories Din,ensions of same structure with alterations or additions: Front ....................................Rear Def th ................................ Height ............................ Number of Stories ................................ 8. Din~ensions of enfire new construction: Front ....11~ .......................... Rear '""~r .................. Depth "'"2~ .......... Hei iht .................... Number of Stories ..... .~'1¢. ............ 9. Siz, of lot: Front ~,.~[0..~.;]~O ...... Rear .................................... Depth .],~0../~/~92, ........... 10. Datle of Purchase ..........196.7. .................................... Nome of Former Owner ...(~,~4H'~,.~l~. ........................ 11. Zor~e or use district in which premises are situated ....... !!]].l.!..&t_~t ............................. 12. Doe? proposed consfruction violate any zoning law, ordinance or regulation? ......... t3. Na~ne of Owner of premises .~.&~1...¢~,~'~¢. ....... Address ,.N¢~...~ll;[.:~O],~ ................. Phone No. No,ne of Architect ...................................................... Address ............................................ Phone No. Na(ne of Contractor .~..,~l~.~e~.~..~,~.tt.~Ci~L~&~ddress ............................................Phone No. Ohesh~re Elee Ambassadom' Plum~/~ D~AGRAM Locatp clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions property lines. Give. street and block number or description according to deed, and show street names and whether i'n :erior or corner lot. STATE O~ ND¢~ YJD.~RI~,, / ~ ~ ¢ COU F~TY i OF .,~..~...~ ..............~, ...... >1" ....... l ................. ]B~t']LI'~"e"'O'I&~j~ ............................... being duly sworn, deposes and says that he is the applic (Name of individuaV~signi~Ig application) above nar~edl~l-te is the .......~I1.{t~ ........ ~_..' .' ' '~ "- (Contractor, agent, corporate officer, etc.) of said or owners, and is duly,,authonzed to perform or have perfc~rmed the said work and to make and this appli, that,'all ont.ained in this application are true to the best of his knowledge and belief; that 'the ~ ark will be )erformed manner i~et forth in the application flied therewith. Sworn to ~ day .~... ~ , tl~l~.~. ....... 19..~.~. Notar