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Home My WebLink About5024-z FOEM NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S oFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISEs UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°. 5024 Z eo~e ........................... 0~.....23.., ]9..,...~0 Permission is hereby granted to: · -~e~s-..~e~.~:e~,..-..~/G ..~e*rge..6J~etoe.-. at premises located at ........... [O~...~.~l...~a,~e~...H~ ........ '.......~ .......... .: ....................................... ................................................... ~..~>.z,~ .~. ~.a .......... ~,~...,~ .................................. pursuant to application dated ......................... .Ot3.t,....;~.~ ............. i-.., 19....~ and approved by the Building Inspector. I~sp FOB~ NO, 1 I~OWN OF soUTHOLD BUILDING DEPARTMEN1 TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E×om~ned ...... :.:....::'..:.i:i :L :Z. .......... , ~9 " , ,, o,' ~,~ 0 / -I .~...~. Approved ........................................ , 1,..-.,... Permit No..-. .................... Application No ............................. APPLICATION FOR BUILDING PERMIT ................... , INSTRUCTIONS a. This application must be completely filled in by typewriter or in !nk und subrnitted in duO,ate to the Building Inspector. b. Plat plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and g ring a data ed descr ptlon of ayout of property must be drawmon .he d~agram wFuch ~$ part of this application. c. The work covered by this application may not be commenced b~fo~e issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue o Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the progress of the e. No building shall be occupied or used in whole or in port for any p~Urpose 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, ~nd other applic~ble 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, ~de, and regulations. (Signatpre cf applicc~t, or name, if a corporation) ........... ......................... ' (~'~';;ss ai ,spp(~co,~) ............ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. r~ e P '~ ~'" 7" .............................. If applicant is a corporate, signature of duly authorized officer. 1. Location of land on which proposed work,~vill be done M~p N/~.,..~...~ Lot No.: ~ .................. ........................ fl .............................................. ................ Zi~dnic~,~ .................................. 2, State existing use apd occupancy of premises and intended use a~d occupancy of proposed construction: a. Existing use and occupancy //,~,-K~/,r~ ~ b, Intended use and occupan:', ..................................................... : ............................................................................ 3, Nature of wink (chock whicl~ applicable): New Building .................. Addition .................. Alteration ............. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ...................................... 4. Est mated Cost ....~-~...~..O.l~..~......j.~ ..................... Fee ..... ~.....~...,.~'~ ................................................................ -- -- (to Be paid on filing this application) ,5. If dwelling, number of dwelling units ........ ~.,. ............... Number of dwelling units on each floor ............................ If 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 .t .......................... Rear ................... , ............ Depth .................... Height ........................ Number of Stories ................................................................................................................. 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 ../...~.. ......... Number of Stories ..... ~ ................................................................................................ 9. Size of lot: Front ...... /.~...~,~ .......... Rear .././.....~.. ......................... Depth .../.....~...~. .................... 10. Date of Purchase ........................................................ Nome of Former Owner ........................................................ 11. Zone or use district in which premises are situated .....~..~..:....../..$...: ....................................................... 12. Does proposed constructlon viqlate any zoj~i.ng law, ordinance or regulption? ..~..../~....~ ............................................... Name of Architect ...................................................... Address ............................................ Phone No .................... Name of Contractor ~~..: ........................... Address ............................................ Phone No .................... PLOT DIAGRAM Locate clearly end distinctly a~l buildings, whether existing or proposed, end indicate all set-back dimensions from property lines. Give street and block, number or description according to deed, and show street names end indicate whether interior or corner lot. COUNTY Of ~.:;~..'.~...~.::!/.~z..;_.Y~:~' r ................ · ~....~,,.~,...~..'~'T.... ................ being duly sworn, deposes and says that he '~e applicant (Name of ir~'ividuol si~ing application) above named. He is the ......... ~~ ............................................................ ~ ...................................................... (Contractor, agent, corporate otricer, etc.) of said owner or owners, and is duly authorized ta perform or have performed the said work one 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 in the application filed therewith. _ .............. ~.~ day of ........... ~~ ........ ,. ,