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Home My WebLink About6185-zTOWN OF SOUI'HOLD IUILDING DEfARTMENT TOWN CLERK'5 OFFIC~ SOUTHOLD, hr. Y. BUILDING PERMIT ('THIS PERMIT MUST BE KEPT ON THE Pl~EMISES UNTIL FULL COMPLETION OF THE WORK ^UTHOR~ZED) permission is hereby granted to: .......... · ~.~...~r ................................... at premises located at "~,'~"I~'~"~'II; ............................................................................. ........................................ 3r~,~t~e..~..',l~a~el~e .- ~lt.el!ll ....... I.~'~.~ ................................... pursuant to application dated ................. ~l~lit. ............ ~ .............. , 19.~.., and approved by the Building Inspector. Fee $.1.~ ........... .. ,/ FORM NO, ! TOWN OF SO~T,OLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. [ ;-:~ Application No....~'.. ~' APPLICATION FOR BUILDING PERMIT ,~ Date ..0~...~.O..~.?.....]....~., ............. , 19...~... .... ~ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Pict 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 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 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, Ord. i~l~-n~es 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, and to admit authorized inspectors on prj~m~s and in buildings for necess~ inspections. (Signature of applicant, or name, if a corporation) 302 Colum~um AvemAe ....... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder; Name of owner of premises ~EltIoZ~, ~ro ]~ If applicant is a corporate, signature of duly authorized officer. 1. Location of land on which proposed work will be done. Map No.: ...... ~.-..'~.... Lot No. ].2 Street and Number .................. ~31~ ................................................................................... ~1~.~.~.,.~...:~. ....... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... ,,'~DD~ ............ ~"ool ~.~t b. Intended use and occupancy .................................................................................................................................. Nature of work (check which applicable): New Building ...... X .............. Addition ..................... Alteration ............... Repair Removal ......................... Demolition ........................ Other Work .................................... (Description) Fee ............~..,~.(~). ....................................................................... (to be paid on filing this application) ;number of dwelling units ................. Number of dwelling units on each floor ......................................... number of cars ............................................................................................................................................ commercial or mixed occupancy, specify nature and extent of each type of use ..................................... ~f existing structures, if any: Front ..................... Rear ........................... Depth ................................... Number of Stories ............................................................................. i ' 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 ......... 10.! ................................. Number of Stories ............. ~. ......................................................................... 9. Size of lot: Front ........ ~.0~ ..................... Rear ..........,~.! ......................... Depth ......... ~J.0.! ................................ Height .................................................... Number of Stories ...................................................................................... 10. Date of Purchase .....0~....~.....,~.~..~. ............. Name of Former Owner ..~l",~l~l~...~lJlJJ~J~..~..~.t,~4~.l[I.a...~/~jll~.A ....... 1 1. Zone or use district in which premises are situated ...................... ~ ............................................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ....... ~.q. ............................................... 13. Will lot be regraded _ .~...O. ........................ Will excess fill be removed from premises: [ ] Yes ~J[ No 14. Name of Owner of premises .,,~I~.~...~A..,,~g*~,~,...~,~(~..~Ot::)~.O.IZ~],,~,..,~B.. ............... ~:[,l..--..~.8~..'1 1 ~. ......... FA=~' ]~,~,.~'~.1, ~,~'JAddress) 0~60~ (Phone No.) Name of Architect ................ ~ ........................................................................................................................... (Address) (Phone No.) Name of Contractor ............. ~ ........................................................................................................................ (Address) (Phone No.) Locate clearly and distinctly~/ property lines. Give street and bio' er interior or corner lot. PLOT DqAGRAM STATE OF NEW YORK, ) ~-'. COUNTY OF ...................................................... ) .......................................................................................................... being dmz-- and says that he is the applicant above named. (Name of individual signing contract) .\ He is the ..................................................................... (Contractor, agent, corporate officer, etc.) 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 3tatements 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 .................................................. 19 ............. Notary Public ...................................................................... County (Signature of applicant)