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HomeMy WebLinkAbout158-zNO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES ',$/~,~,~,~dD~,~ ~i~'~i~¥~i~,~t~a,f~,~NJi~~,UNTIL FULL COMP. LETtON OF THE WORK AUTHORIZED) No ..... .g....!~.8. ....... Permission is hereby granted to: Chet, Date .................. Oe.to:oe~ ....... 22 ........... 19..~... Orlo.~slc~.....~'.O.....$~ueZ..Totte~ ..................... ........ Cate~og~e .................................................. ......................... N,.~., .............................................. to ....Build...new...dwelling ............................................................................................................ at premises located at .~/~'""Ola;~;'"l~O~ ....................................................................................... ............................................... ~o~tl~ld ............................................................................................. ......................................................... ~I,~ ............................................................................................. pursuant to application dated ................... 0~,~;ObGl~.....2,C~ ................... l g~...., and approved by the Building Inspector. Fee $ .~...0..,. ~..,.. ~ .~..~:a FORi~I NO. 1 TOWH 0~ S~UTHOLD BUILDING D£PARTMENT TOWN CLERK'S OFFICE SOUT.O,D, N. Exam ned ....... ~.~...~.. ?. ....... 19..~?. Approved ........................................ 19 ........ Perm ~ ~o...~. ............................ Disapproved a/c .... (Building Inspector) Application No ............................ 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 part 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 a~plicont, or name, if o corporation) , . of applicant)Z-"'" ................... State whether ,pplicont is ~wner~ lessee~ ~ent, orchitect~ en~ineer~ 0enerol contr~ctor~ e~ectric~n, plumber or builder, ..... ....... o, .............................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Location of land on which proposed .work will be done. Map No ...................................Block .................................. Street and Numb r .~....~.5....~.d ............ ~ ................................................................... State existing use and occupancy of premieses and intended use and occupancy of proposed construction: a. Existing use and occupancy ........................................................................................................................... b. Intended use and occupancy ........ ~..~ ......~7 ............ 3. Nature of work (check which applicable): New Building ....... ~.~ ......... Addition .................... Alteration .................... Repair .................... Removal .,~ ................ Demolition .................... Other W0~k (Describe) .................... 4. Est mated Cost .. /.. ~ : .M tee ............................................................... (to be paid on filing this application) FEES: 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 ................................ 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 ....... ..~.......~. ............ Rear ........................ '~ ¢) ' .... Depth .....':'~......~./ .............. Height ....../...~...'~../../~.....'... Number of Stories ........... ./. ............... 9. Size of lot: Front ....... :.-~.~..~.~ ....Rear ...... ..~"O Depth ........................... / 10. Zone or use district in which premises are situoted.~....~......~.::/ ] 1. Does proposed construction violate any zoning law, ordinance ar regulation? ...... ~ ...................................... q-.L _... o . '7 ' 12. Name of Owner of premises.,~.~¢.~,,~..i~..,.+.~ddress ¢..~..-..,......,...,..,......~... ....... Phone NO ......... :.. ......... Name of Architect .......................................... ~ ........... Address ................................... i ........ Phone NO ............... ; ...... Name of Contractor....~,,~.~~ ........... Address ~~,r,h,,,yz..Phone NC~,).~..:',~.:,'.~..~,~.~- 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. STATE OF NEW YORK, -- ) SS..' COUNTY ,,OF ~~.....) ....9~.....~.~,,~~.: ............................... belng duly sworn, deposes and says that he is the applicant (Name of individual signing application) 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 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 .... 2.~ ............ day of ............ ~..' ................ 19...~'[..7.... Notary P u b I i c,..%~K,,YJ,.ct,¢~.~. J.~ ............... County N'ot~ry Public State of New York Res ding in Suffolk County No, 52-0367800 ._%~:~ My Commission Expire~ t~larch 30, 19 · / (Singoture of applicant) FO~ ~0. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ed ~ '~- ? 195'~ Exam n ........................................ " ~' No~.'..'~~.z.. ~ Approved ........................................ 1 9 ........ Permit Disapproved a/c .................... ,..~ .............. ~.~ ~=.:: ..................... :,~,. ,r.-.; ........................ (Building Inspector) Application No ............................ APPLICATION FOR BUILDING PERMIT Date .......... ' ...................... ! ........................... 19..~..~..?.. INSTRUCTIONS a. This application must be completely fiiled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing locution of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detuiled description of layout of property must be drawn on the diagram which is part of this locution. 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 o Building Permit to the applicunt. Such permit shall be kept on the premises available for inspection throughout the progress of the work. e. No building shall be occupied or ussd in whole or in part for any purpose whatever until a Certificate of Occupancy shall hove been grunted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Depurtment for the issuunce 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 oil applicable laws, ordinances and regulations. .... .................................. (Signature of applicant, or name, if a corporation) ..... · ~.....w:..::.d; ................. ~.....7 ........................................ (Address of apl~licant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, eJectrican, plumber or builder. ......... ;t,,.~ .~....... '..(Z~.~-~x~ ..~..~ ....................................................................................................................... v . . ............... Name of owner of prem ses ,.~" ~~ : ' ~-'~ ~J~ ~ .................................... 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 ,...L,cz~.. ,~.,.0,~/:~.-.~.~.~/..:..~.....:..~.'4~..q-r..~.~.?.-~.r.~..C''. ......................................................................... State existing use and occupancy of premieses and intended use and occupancy of proposed construction: a. Existing use and occupancy .................................................................................................................................. b. Intended use and occuponcy...?.~L~.....~.'-4r~..,~....'.~'~2...'~'-" ~ ..'TT ~ ~f~-)'' ' : . , . 3. Nature of work (check which applicable): New 13uHding ...... Z~. ......... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition. ................... Other Work (Describe) .................... / 4. Estimated Cost ..... .-/....Q...~..'..~ ........................... Fee (to be paid on filing this application) FEES: / If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ........ ./. .................. If garage, number af cars ................'..-Z. .................................................................................................................... 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 ............................ 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 ....... .~...?. ............. Rear .......... ..~....?! .......... Depth ......~....~.. ................ Height ......... /..~ ............. Number of Stories ........../ ................ 9. Size of lot: Front ....... .S..~..~. ............... Rear .......... ~.o.'. .......... Depth ....... ~.~...~ ......... J0. Zone or use district in which premises are situated.~.....~¥.....Q.~.....~... 1 1. Does proposed construction violate any zoning law, ordinance or regulation? ......................... :....,3.~,. ................. 12. Name of Owner of premises;,:~..:,..--~--~..,~-...~.~ddress ,..=.........:..m.:..,.. ...... .=....... Phone NO ..................... Name of Architect...._.... ....................................... ~ ...... Address .......................................... Phone NO ..................... Name of Contracto~.~'"~.~.'.: ...... Address ....... PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate al/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. / STATE OF NEV~ ¥O,R?,. ,~ ) S S, COUNTY/~F ~......),"~ // ~ /x/"h /) _ /) ' ..,%,...~. ,~...~: ............................... being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the .............................................. ~...r-A...~ ....................................................... (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 .............. ~ ................. 1 9..~.'~.7.,.. Notary Public,.~.~ ............. aunty ~LOISE BOWDEN N'otl~ry Public, State of New Yol~ Residing in Suffol]( County No. 52-03~7800 (Singature of applicant)