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Home My WebLink About4708-z FORM NO. ~ 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? 705 Z Permission is hereby granted to: at premises located at ............. ~l~..~....~l~,e..~l~....&i~,..~, ...................................... ................................... I~......~..~,~..~ ............... I~.emm~ ................................................ pursua~ to application dated ......................... &~'.~;....~b ............. , 19..~1)., and approved by the Building Inspector. I~ORM NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 19 ........ Permit No ............................ ~. Disapproved a/c ........... ~~~...~...~.~....~ ........................... ~'l~'~ii~*i'~'~'*lnspect~c~'~ ................................ APPLICATION FOR BUILDING PERMIT ........... .................. , Date 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, buildin9 code, housing code and regulations. (Signature of al~licant, or name, if o corporation-) - (Address of applicant) State whether applicant is owner, lessee, agent, ar~h~t, eng//~j~, general contractor, electrician, plumber or builder. Name of owner of premises ........... ............. ~ I, applican~.'s a_ .corporo, t,,~e, ~natu~e of~l~y authorized offic'r. ........... ................... 1. Location of land on which proposed work will be done. J~Aap No.: .. .~..~.... ot No.: ...~ ................ Street and Number .......... ,~m~. ~,~,~....~,~ ........ ~'~'~i~' ...................................... 2. State existi.ng use and occupancy of premises and intended use and occupancy of proposed construction: i3. Nature of work (check which applicable): New Building ...... ~.... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ Estimated Cost ........../..~..~.~ .................................... Fee .......................................................................................... (to be paid on filing this application) If dwelling, number of dwelling units ........... ~.~..' ......... Number of dwelling units on each floor ..... ~ ................... · If garage, number of cars ... ~ .................................................. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ Dimensions of existing structures, if any: Front. ........................... Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ NUmber of Stories ................................ Dimensions of entire new construction: Front .......... .~...~ .................... Rear ...... .~....~ ............... Depth ....~.~.....~.. ........ Height ........ ./..~. ........ Number of Stories ...' ............ ./. .................... i .................. ~...... ...................................................... Size of lot: Front ......... ./...~. ............. Rear ............. ./- .~(.. ................ Depth ........ ..~..~,..~.. ............. Date of Purchase ........................................................ Name of Former Owner ........................................................ Zone or use district in which premises are situated .......... ~ ................... Does proposed construction violate any zoning law, ordinance or regulation? ............ ~ .......................................... Name of Owner of premises ..'~.~..~m1.~...~.~...~. ........... Address ..././..~/..~....~..~.¢...t(.s .~.e'.~/..?...~l~hone No. ~ ~.~....~..~....~. Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .~.~....~..~..£S ........................... Address /~,.~...C..~..~...Z...%.....~.~.~ ........... Phone No...~...~....~....~...~../..~ ~' PLOT DIAGRAM · L acute clearly and distinctly all buildi)ngs, whether existing or proposed and indicate all set-back dimensions f~om property lines. Give street and block nuJmber or description according to deed, and show street names and il~dicate whether interior or corner lot. STATE OF ND/k~P,~ el J$$ COUNTY ..................... ~¢-,~c:~]~ ........ ~.. .............................................. being duly sworn, deposes and says tha* he is the applicant (Name of~JJ~dividual signing applic~on),~ .~'~' ~/j~,~ · (Contractor, agent, corporate officer, utc ) of said owner or owners, and is duly authorized to perform or have performed the said work and to rnoke and file this application; that alt.Stateme~nts contained in this application are true to the best of his knowledge and' belief; and that the work will be performed ih the manner set forth in the application filed therewith. ELIZABETH ANN N£¥1LLE NOTARy PUBLIC, State of New York No. 52.8125850, Suffolk Co.,~j,~