The URL can be used to link to this page

Home My WebLink About5055-zFORM NO. 2 TOWN OF SOUTHOLD ~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y- BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISE COMPLETION OF '~HE WORK AUTHORIZED) UNTIL FULL 5055 Z Permission is hereby granted to: ~ at premises located at .......... ~/~..~hJltl~]tJlJl-~J~*~*~9'~,:'~[~....~ ~ ........................... pursu~n~' to application dated ............................ ~ ..........~.,...;.,., 19.Jjl([~,., and approved by the Building Inspector. !Building I~spector · ~ TOWN OF SOUI'HOLD · ~ ~, ~- TOWN CLERK'S OFFICE '/~?l/~- : .... ~__ - t, ^pproved ........................................ 0 It ........ Permit No .......................... D,~appraved a/c ......................... ~ .... ~.. ......... (Building Inspector) APPLICATION FOR BUILDING INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink ;,nd submitted in duplicate to the BuildingS. Ir~pector. b. Plot plan showing location of lot and of bu.ildings on premises, relationship to adjoining premlee~ or I~blic streets areas, and giving a detailed description of layout of property must be drawn on the diagram whl~h It port of ihle al~llcatton.~ c. The work covered by this application may not be commenced before iguance of Bulldtng Permit. d. Upon approval of this application, the Building Inspector will I~ue a Building Permit to the al~lJ~-'~nt. ~ permjt~. shall be kept on the premises available for inspection throughout the pmgre~ of the work. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of shall have been granted by the Building Inspector. '~ APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permtt PUmua~ to the~? Building Zone Ordinance of the Town of Southold, Suffolk, County, New York, end other appll¢?.ble Regulations, for the coriltruction of buildings, additions o~alterations, or for removal or demollhon, ee herein The applicant ag~es to comply with all applicable laws ordinances, building code, housing cnde, and regulotlonl. -~ 1,~ - ~-~ . ~// (Signature cf appll~, or name, If .... ....... State whether applicant is owner, Imee, agent, architect, engineer, general contractor, electrician, plumier or builder. Name~ of owner of premises ....... .,~.g,~g~:~.~...~l~.~Jl~.~.l~ ................................................................................................. If applicant I~'a corporate, signature of duly authorized officer. ~ (Name and title 'of corporate officer) ~- I. L~ation of land on ~lch p~d wo~ will ~ done. Map No.: ........................................ ~t No .... ~ St~ and Number ......... ~~...~...~e~ ........................................................... ..... ~ 2. State existing u, ~d ~cu~n~ of pmmisfl and Intended use and occu~n~ of p~ ~1~. .' a. ~isting use ~ ~cupancy ~.~.~.~..~. ....................................... b. Intended use and ~cupan? ......A~~..~&..~ ................................................................... ~ 3. Nature of walk (check which applicab e): New Building ................. Addition ..... ~.. ....... Alteration ............. Repair .................. Remora! .................. Demolition .................. Other Work (Describe) ................................... 4. Estimated Cost .$,I~.g.n.Q.Q . Fee .~.e.O. 0 (to be paid on fi!ing this application) 5. If dweUing, number of dwelling umts ........................... Number of dwelling units on each floor ...................... If garage, number of cars ................................................................ . ....... 6. If business, commercial or mixed oocuponcy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: F on,' ...... ,,~1-..! .............. Rear ..... .]:.8_! ..................... Depth .... J$2' ....... Height ........... .~ ........... Number of Stories '1 Dimensions of same structure with alterations or additions: Front ...... ..~...t. ........................ Rear 12' ~ ......................... Depth ....... ~.4~.....~..~ ........... Height .......................... Number of Stories ................................ 8. Dimensions of entire new construction: Front ..... ~d,.I. ........................ R ear ......~-,1~. ................. Depth. ~,~.!...[L~ ....... Height ...... J~..~ .......... Number of Stories 1 9. Size of lot: Front....~..0'............. ..... .. Rear ........ ~.~.. ....................... ' Depth ~..0..! ........ 10. Date of Purchase ...... ~./.]:.c)..~.0. .................................... Nome of Former Owner /~£ k'. ..... Vi.o.!et; .......... ! 1. Zone or use district in which premises are situated Residential 12. Does proposed construction ~,iolate any zoning law, ordinance or reaulation> Name of Ow .er of "-'- .-.- Name of Architect ...................................................... Address ............................................ Phone No .................... Name of Contractor Barney. p, Harris Address ~.~.~.~.~.u.q~ ............................................................ Phone N o.~ T...~..~..~..-~..... PLOT DIAGRAM Locate clearly and distinctly oll buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and b~ock number or description according to deed, and show street names and indica~'e whether interior or corner Jot. //~/J-/7~'~J;; ~'~F~EJ~ STATE OF NEW~-OP, I~, fl~. J__ ~ COUNTY OF ..iI~,~,,-~//~' ........... }-b..~. · ~ ~ ;.~ :....~,J~.. ~" ~ ben du sw rnsw~ f ' , ................. .................................... 'g duly ',Ldeposes. aha says thor be is the app,icant tr~ame of individual signing application) J ~ above named. He is the ............................ ..~..~ .................... k- ...¢~-- ..1 ........ (~ontr'"- ' bctor, a~'~"~i~'~';~'~;~i ............... of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; that the work will be j~erformed in the manner set forth in the application filed therewith. Swam to before me this ........."'" - ..................... · HENRY G. STEPNO~. J'l~'~'-~'~';-''' ..... "~'~, n ~ g ppbcant) i~ot~ry Public, State of New Yorl{ ~;~/..z..~.~,~. ~,..~ C ~,,°~'rn~s2~igolnS!E0xSp ,0~'e sS uMf fa°;ckh g~) n tiYR ~.. / ' I -