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Home My WebLink About3662-z FORM 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? 3662 Z Da¢e ........................ .0...c..~.9.b.~.~..... 9 ........ , 1 Permission is hereby granted to: G ~. p.~. g.~... ~.~Z'~ ~....-....~..~m~.~. ......... ~m~.:t.g..o~¢~...~.o~,~. ...... .............. ~.¢~,..J at premises located at ....~J./.~... ~ad pursuan¢ to application dated Building Inspector. Fee $ ~.~...0...0. .............. ...c~ ............. , 19..~?.., and approved by the TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exam,ned r 19....¢..? Approved ........................................ , 19....i... Permit No ........................ APPLIGATION 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 drown on the diagram which is part of this application. c. The work covered by this application may not be commenced before issue.rice 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, housing code, and regulations. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engi.neer, general 'contractor, electrician, plumber or builder. ................ .~f~zt.t;. ...... ~,~. .....l~:L3, r4 ~ ................................................................................................................... Nome of owner of premises ..FJ.,~,L[~[~..~.~ ....... Ag~ig~..P.?~tl~Z' ............................................................... 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 dane. Map No.: ......... ~ff~¢ ....................... Lot No.: ...~ .............. Street and Number .,~[k~...~:i~'.~:~P.~)...~q~ ....... ~a~ .......................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of propos~ construction: a. Existing use and occupancy ...~,~D,].~,J~ ............................................................................................................ b. Intended use and occupancy ...... ~O...~/.~f$..~TL..~C~.~,~D~ ........................................................................ 3. Natbre of work (check which applicable): New .................. Addition ..~ ......... Alteration Repair .................. Removal ................................... Other Work (Describe) 4. Estimated Cost ........................................................... Fee ..... I (to be paid on filing this application) 5. If dl~elling, number of dwelling units ...... .c).~t~q ............... Number of dwelling units on each floor If g~rage, number of cars ................................................. 6. If lJusiness, commercial or mixed occupancy, specify nature and extent of each type of use 7. Dimensions of existing structures, if any: Front ............... .1.b~. ....... Rear ................. ~,.% ......... Depth ........ ..~0 ...... Hei.~ht ........................ Number of Stories Dim'ensions of same structure with alterations or additions: Front .................................... Rear / Dep~th_ ................................ Height ...................... ......Number of Stories ................................ 8. .D n~ensions of entire new construction: Front ...... .~0 ......................... Rear ........... .d, 0 ............ Depth ...... 20 ........ Height .................... Number bf Stories ......... 9. Siz9| of lot: Front ...... ~.0.(,} ............... Rear ...... 'I0.C) ...................... Depth ......~00 .................... 10. Dutb of Purchase ........................................................ Name of Former Owner 11. Zon[e"or use district in which premises are situated . ..,~.....,,;I,,~.v .......................... 12. DoeJ~ proposed construction violate any zoning law, ordinance or regulation? 13. Narhe of (~t~oat~p~remises ...~fLO.~:&~..~:~,~ ......... Address ......... .};].?,.~.(.(2~J.~4~ ............. Phone No. · Nar~e of Architect ...................................................... Address ............................................ Phone No. Nar~e of Contractor ...~.f~9.. ........................................ Address ......... J.'.~J:,~.:L~¢~ ............. Phone No. PLOT DIAGRAM Locat clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fr property I nes. Give street and block number or description according to deed, and show street names and whether in :erior or corner lot. COUNTY IOF ........ e..~L.~:./~..O..,I,.g:. ...... f ,~.,o. ................. .............. .~..~..O...~.lg~....J.~'~'Z~ .................................... being duly sworn, deposes and says that he is the opplic ~(Norne of individual signing application) ' %'e~.a~ ,~ B.~t~lcl.~;~ .................. above named. He is the .................................................................................... (Contractor, agent, corporate officer, etc.) of said o~ner or owners, and is duly authorized to perform or have performed the said work and to m.ake and this applidation; that all s~atements contained in this application are true to the best of his knowledge and belief; that the wbrk will be perfor'ned in the manner set forth n t'~e applica?on filed therewith. Sworn to ~efore me this " ' ................ J......~. day of .......... ' ........ .0.?,~;o..b.~..P.. ..... 19....(2~. z Notary Public, :.~M.....kfl~ Ki~I~qz. ute of apl '] ~IOTARY PUB State o[ New No. 30 Suffolk Coun,t~ : ] Commission Expires March 30, 19~_~ /