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HomeMy WebLinkAbout6-zFORM NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. Date ............................... ..(r,¢/;. ........................... V hereby granted to: ........... .~.~...~-.~ ................................... ............... ??,.¢~:~?~..~.~<. ....... ~ at premises located at .................. ~/~-. ......,~ rl ~,~...~:;;.,...~ .......................... ......................................................................... ~/.¢...~:.~:¢. ?.:~:~.,:~¢. ~:..~&~ ......................................... pursuant to apprication dated ........................... ~.~.~..z.-~. ...... ~: ........... 19~.'~...~., and approved by the Building Inspector. Fee $.,,2~...-.~ ........... ~'¢ ¢'~'~ Building Inspector FORH NO. 1 TOWN OF SOUTHOLD BUILDING D[PARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ^ppraved ............. .......... ................. Disapproved a/c ............................................................................................ (Building Inspector) Application No....~..~-~ .............. APPLICATION FOR BUILDING INSTRUCTIONS o. 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 port of this location. 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 and regulations. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrican, plumber or builder. .............................................................. ....... '.. ............................................................... Name of owner of pram ses ' .......................... 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. /~ Block Street and Number ...... ..~..c?.k(.'.U..~ ...... ~...U..~.:.,.....-~.4~:..?C..L.~...u...~..~..,.....~...~../.: ................................................................... 2. State existing use and occupancy of premieses and intended use and occupancy of proposed construction: a. Existing use and $ u ~ ,~ f ~ rFo ,'~ ~ b. Intended use and occupancy 3. Nature of work (check which applicable): New Building .................... Addition ....,,,~.. .........Alteration .................... Repair ....................Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ..... .~.'~F~......:...~ .............................. Fee ...~..,.....~...O. .......................................................................... (to be paid on filing this application) FEES: ~)~-~-~' mQ 5. If dwelling, number of dwelling units ......... ~ ............. Number of dwelling units on each floor ...... ~ ................. If garage, number of "~- cars ..................... r .................................................................................................................. 6. If business, commerical or mixed occupancy, specify nature and extent of each type of use ...... ~ ...................... 7. Dimensions of existing structures, if any: Front ....... ..~....~.../. ........... Rear ,~ c// Depth Height ..... /...m. .................. Number of Stories ......... ./. ................................................................................................... Dimensions of same structure with alterations or additions: Front z./,W/ Rear ~/ Depth ...... ~..~T....~../..... Height .............................. Number of Stories ................................ """ 7" m'9 8, Dimensions of entire new construction: Front.....~..~.....~. ............ Rear ............................Depth ............................ Height .......... !...C)...'. .......... Number of Stories ...~ .......... 9. Size of lot: Front ~c~,~ .~,~ Rear ,~2C7 -5~ Depth L.~ '~' 10. Zone or use district in which premises are situated ......................... ZJ.....~?.~ ............................................ 11. Does proposed constructiot~ violate any zoning law, ordinance or regulation? ...... ~ ..................................... 12. Nome of Owner of premise .:.. .c...~.. ........ Address .~./.~.~r~ : ............... Phone NO Nome of Architect ......................................................Address ............................................ Phone NO ..................... Name of Contractor ~×..'~...~' ~',_),.~....r~. ..~z~tf...~..~;.~..~¢..~-..~...~;..~ .............. Phone NO. .............. ~. ....... ,,/ ................... Address .................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block numbers or descriptio,n according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YO,RK, ) - ........... ~..........' '~ ~ ................ ~ ........ being duly sworn, deposes and so~s thor he is the oppllc~nt ~om~ndividual signing application) above named. He is ~ .............. ~.~ ...................................................................................................................... (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 be performed in the manner set forth in the application filed therewith, Sworn ~to before me this ........ ...... day,of ..... ........ ........... .... Notory P u b I i c,....~;~.~o~r~.. -$'.~..~.~//(. c o u n t y No. 52-4,040975 Jqo~a~, Public in ~he State of I~ew ¥or~ Residing in Suffolk County Comml~nlon Expir~ Maroh 30, FOI~I NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. Approved ......... !.! ............. :7. ............ 19...'~..~.Permit Nol..~..~.7 .................. Disapproved a/c ............................................................................................ Application No.....~.'~.....~ .............. APPLICATION FOR BUILDING PERMIT D te 7 ,03-7 INSTRUCTIONS o. 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 [at and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving o detailed description of layout of property must be drown on the diagram which is port of this location. 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 port for any ~urpose whatever until o Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of o Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lows, 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 and regulations. (Signature of applicant, or nome, if o corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrican, plumber or builder. 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. Mop No. Block State existing use and occupancy of premieses and intended use and occupancy of proposed construction: o. Existing use and nccunnn~v ~.,~'.~A~'/~/ rJc)~,~ 6' b. Intended use and ~ ............................. r ................................................ / .......... : .......... 3. Nature of work (check which applicable): New Building .: .................. Addition ...... ~........Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ................................................ ~ ~ ~ ~ ..~..~./ ........... Fee .......................................................................................... (to be paid on filing this application) FEES: /~0~.~ 5. If dwelling, number of dwelling units ......... .~. ............. Number of dwelling units on each floor ............................ If garage, number of cars ........................................................................................................................................ 6, If business, commerical or mixed occupancy, specify nature and extent of each type of use .....'.5 ................. 7. 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 ................................ 8. Dimensions of entire new construction: Front ...... .z~.....~.../. ........... Rear ....... .<~....~....~ .......... Depth ....... .?....~...~ ............ Height ........... .~..~...z. ........ Number of Stories / 9. Size of lot: Front..~.../...o........~.../. ..... Rear ..... ........... Depth ......... 10. Zone or use district in which premises are situated. Z~.?~./~.¢~..7'~.~...Z ...........~. ,/=.;.~..ci....~..T..~.....~...~., ..................... 11. Does proposed construction violate any zoning law, ordinance or regulation? ............... ~....~.. ............................ 12. Name of Owner of premises...~?.~...q-.../C...z..~...~...~...~...~.~.Address ..~?.~..~..~'...~...~..e..../~,i~Phone NO ........ Name of Architect ...................................................... Address ............................................ Phone NO ..................... Name of Controctor..~..?~.~:'~.)4'....,..~..~.~.../C.9.-- ............. Address ...,~'.~.¢4...~....z~...~...e,..:..A..~ .~.~,.Phone NO. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner lot. SmAT OF NEW,_. ) s s cou uw OF ........ ) '~"'~"~"~~'~i~i~"~'~ii~i~'i ............... being duly sworn, deposes and soys that he is the applicant above named. 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 statements contained in this opplication ore true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application flied therewith~ Sworn to before me this ~ , ....... ~ .............. day of ...: ............ .~ .................... 19~.~... - ' ~ 0 o pp' on j ~o. 524040~75 ~ota~ ~ublic In th~ 8taro o~ ~ ~ffi ~ldlng in Suffolk Ooun~ ~OffiF~l~s~n ~plre8 M~ $0, l~c/ UrpI—N ,( SuDtMT�D C( !/ s JU S C-f�l (, ALL i S r i 'M jJ l {, 9.2 c F Svc /Q�.p r1 I rl) p Q 0 5 rAIM cD J 0 � V ; NS'9" lR P(PF A — FY15 r Ntw �y orl A PPI T,otJ �Y"srA4 P) 1 Q , v CONC+ Moi✓ O. IS'NokTr/ 1 ; orn,cHw,gy Lf/Yt' — Q2 9 3. 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