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Home My WebLink About5843-z 1PO~ 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? 5843 Z Permission is hereby granted to: eec .~z'~r.~..J~:..~.l~..r~..&N.~l~z~l~.& Ji ~eh ..... · Je~t~e~.e~ ....................................................... ~o .~t...~.C~enea..~...~d~e.. ~/~ ................................................................................................ at premises located at ..... I~,,~l,:~i~,..~ll....~.~.~..l~a~ .......................................................... ............................. Otf..l~&..bleseai ...... ,kit ............ tteatlbel& .............................................. pursuant to application dated ........................... ~d,~F ....... ~ ........... , 19..~., and approved by the Building Inspector. Fee $"J~[e(~ .......... Building Inspector I~)BM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ........................................ , 19 ........ Pemit No ...... ~ ....... (Building Insl~ctor) APPLICATION FOR BUILDING PERMIT ~ Dote ~.~.. ..... ~ ............ ,9....~...~~' INSTRUCTIONS a. This application must be completely filled in by tybewr ter or n ink and submitted in triplicate to the Building Inspector, w th~, 3 sets of plans, accurate plot plan to scale. Fee according to schedule. · .b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and~t g~vmg 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 pert for any purpose whatever until a Certificate of Occupancy shall have bee~l: 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 Yo~k, 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 al~licable law-~ ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary Inspections. (Address oT applicant) State whether applicant is owner, lessee, agent, a.rchitect, engineer, general contractor, electrician, plumber or builder. ............................. ....... .r.. ........................ ............................................................................... ...... .......... Name of owner of premises ....... .~. ......................................................................... 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 done. Map No.: ......'~... ........... Lot No ...... ~ ................................... Street and Number ....... ~...~..~.... ............. .~..~.........~/~ .......................... ~ ....... ~ ..~.~.. .................................... Municipality' 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: ....... ..?.... a. Existing use and occupancy .......... ~ ...~ ............ ~../~/.~,~.. .......................................................... b. Intended use and occupancy ............... ..~'..~..~.. .............................................................................................. J 10. 11. 12. 13. 14. Nature of work (check which applicable): New Building ....................... Addition .......... ........... AIterption .......... ~ .... Repair ................... , ..... Removal ......................... Demolition ........................ Other Work .~.:'~;~'.....,..; .... ~ .~.~ { ~),scription) Estimated Co~ ........... ~..~ ............................... Fee ................................................................................................. (to be paid on fili~ this a~li~tion) If d~lling, numar of d~lling units ................. Numar of dwelling uh~ on e~h floor ...; ..........'. .......................... If ~r~, numar of cars ...................................... ~. .................................................................................................... ; If busine~, commemial.or mixed occupancy, s~ci~ nature and extent of each Wpe of u~ ..................................... Dimensions of exi~ing ~ructur~, if any: Front ..................... Rear .......................... DePth ................................... . Height ........................................................... Numar of Stories ............................................................................. Dimensions of same ~ructure with al~rations or additions: Front.. ......................... Rear ......................................... Depth ............................................. Height ......................................... Numar of Stories ........................................ Dimensions of entire new con,ruction: Front ......................... Rear ............................ Dep~ ................................. Height .................................... ; ............ Numar of Stories ..................................................... , ................................... Size of lot: Front ..; ................................... Rear .......................................... Depth .................................................. Height .................................................... Numar of Stories ..................................................................................... Date of Purcha~ ..................................... Name of Former Owne~ ............... 4 ............................... =~.. ....................... Zone or u~ d~nct In which premiss are s~tuated .................. ~ ..................... .~ ................................................. D,s ,ro,o,id c2n~rueti~, viol~ti~ an~ zo~in~ law, ordin~n~ or .;lafion' ....~.~ ....................... Will lot ~ m~d~d ......... ~ ................ . ........ Will ~x~ fill ~ mmo~ from ~mmi~:[ ] Yes . ~o .................. " .............. " ...................... ~' ...................... (X~;~;';i ...................... '/" (.hon. No.) ........ Name of Archit~t ..................................................................................................................................................... ' . ~ ~ ~ -- (Address) .... (Phone No.) Name Or ~n~rac~or ................... ~.;,;....;. ................................................... .~ .............. -, .................... ;. ..................... (Address) / (Phone No.) PLOT DIAGRAM ,, L ~og~,tp c, lea, d, y ~)nci'di~tinct!y al~ bt~ildings, whether existing or proposed, and indicate all set-beck dimensions from p'ro~elrty Irhlbk; GiW~C:-reet '~r~l block num[:j~r or description according,to deed, and show street nam,es and indicate wheth- er interior or corner lot. ~. // / , ~ ~ t.'i-r~ ,. ~'t ~-,~ / ', ,~ STATE OF NEW YOI~K' ~ //- ) SS COU.T¥ oF .......... ~':.~/....~.~L~ ................. ) ~'~' ~ ~ ~ duly sworn,. ~s ~d s~ys ~at he is the .......................... ~ ................. ~ ................... :~....,~..: ....................... ~g apCh~nt abo ena · He is the ~/~ ~ . ........................................................................... ( ~nt~ctor, a~t, co~te offi~r, etc.) of said owner or owners, and is duly authoriz~to~qrm or ha~e .~rfor~d t~ ~id work and to make and file this applimtion; that all statements ~ntained in this application are t{~t~f~W~ and ~tief; and that tho work will ~ ~or~d in the ~nner .. ~ //_ ~o~,..,.,~:~ ............ ~....., .............. =..~ayo .................. ~ ............................. '~'~"lf~ ~ ~ -- ~ ................................. ,I /