The URL can be used to link to this page

Home My WebLink About10156-z FOI~M 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? 10156 Z Permission is hereby granted to: ........................... .... ~.~.~'.~. ............................................ pursuant to application dated .......... ~ .......~ ............................... , 19.~./~..r~., and approved by the Building Inspector. .Fee $.~..'~'i...--... TOWN OF SOUTHOLD BUILDING DEPARTMENT ~TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No../..O./.~.~.~... ............ (Bbilding Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date ............... ~tp~i]...Z ................. 19..29 ...... 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. Plot plan showing locahon of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of th~s 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 Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulahons, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described The applicant agrees to comply with oil applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. Twin Pork ~'ence Co. (Signature of applicant, or name, if a corporation) ROute 27A ', 't' ~ w .......................... ]~.a .~...g, .~g.g,q.~ ,... ~ .~..... ,~.o.~k ...1. J. 95. ~ ........... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................... .o..o..~ .¢..~ ~.g..¢..o..~ .................................................................................................................................................. Name of owner of premises ..~bo~t&.B...~.~.+,~)~£~B .................................................................................................................... If apphcant ~s a corporate, signature of duly authorized officer. k~. l~errioone (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... Location of land on which proposed work will be done. Mop No,' .................................... Lot No ....................... ~'ac~or .~ve., Matti~uck N,.~., ~. Street and Number ................... ~ ....................................................... ~.~.../(.~....~.. ............................................ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: o Exlsltmg use and occupancy one-£a~ily dwelling b. Intended use and oqcupancy one-£~mily dwelling. ~ '~o.~ ~~-"-~ 3. Nature of work (check which ,applicable): New Buil&ng,. ............. ~,., Addition .................. Alteration '..; ............. Repair .................. Removal ! .................. Demolition .................... Other Work ..~.e.~..a,$~g ................................ (Description) (to be paid on filing this application) 5 If dwelling, number of dwelling units ........................... ~Number of dwelling units on each floor ........................... tf garage, number of cars ......................................... ~ .................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ D~mens~ons of exmtlng structu~'es, if any: Front ............................ Rear Depth Height ........................ Number of Stories ................................................................................................................ Dimensions of same structure, with alterations or additions: Front .................................... Rear .......................... Depth ................................ l~eight ............................ Number of Stories ................................ 8, Dimensions of entire new construction:' Front ....................· ............... Rear ............................ Depth ........................ Height .................... Numberl of Stories ..................................................................................................................... 9. Size of lot: Front 50~ Rear .......... 5~).! .......................... Depth 218~ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 1 I. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance, or regulation: ........................................................ 13. Will lot be regraded .............. i ............. Will excess fill be' removed f~9?o.Pl!i~]ux~uuo~J.s~eN~(r- )' Yes ( ) No Name of Architect ............... ............................................... Address ................................ ,Phone No ....................... Nome of Contractor .............' ............................................... Address ................................ Phone No ....................... : PLOT DIAGRAM Locate clearly and distinctly al, I buildings, whether existing or proposed, and indicate all set-back dimensions from, property lines. Give street and blgck number,,~ipt~.on a cc ording to ~,~, and show street names and indicate~ whether interior or cm nar Io1 q ~,i S'rATE OF NEW YORK, I c c COUNTY OF ....S~t.lt.Z:.oZ.[~ ...........! ~'~ ............ ~.,.....~...e..~..,~..J,..O..o.~.,~. .............. ~ ........................................ b. emg duly sworn, deposes and says that he is the applicant (Name of individual signing contraef) · , . above named. He is the .................. .O.q~J;Z'~.~.~.O:Lq ..................................................................................................................................... (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 statements contained in this application are true to the best of his knowledge and belief; and that the work will b'e~performed in the manner set forth in the application filed therewith., Sworn to,~,,before me this /2 ~, , '/~ I /~ / // / / ......... ............ ......... , Z/_ZJ' // '"Nota ......... ~/~ .... ' ~' ' 6/ (Signature of applicant)