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HomeMy WebLinkAbout415-z FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.o 415 z Date .......................... t~1~'tl~t.....;I..~ ........ ] 9.~... Permission is hereby granted to: ~:~1~1.4.....~ acl~a ................................................... ......... F. at .ti~.ck. ~..... N..Z. ................................ to ..... i~e...~n ..e~i~ ~;lu g...bzu:r~oklL~y, lm ..huildln~ ..t~ ...thi~..],OOa~;;I, Ol~..ll~ ....... ......... r*e~del ..~n~..~n.v~r.t ...$ ~...t~. 4..~ne...f.l~lLy.. 4welLtn~ ...................................... at premises located atll/g..~o~;..l~olc..?u~act~.....~r.th..~:..S9u~..~Va ................................. ............................................... /~*t ~ttuci~r.....N..Y, ........................................................................... pursuant to application dated ............................ ,~,~.t,....],/~ ............ 19..~'.~.., and approved by the Building Inspector Fee SJ.O.,~O~l.....10a~d Building Inspector Examined ........................................ , ........ FORI~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ....................~.~. ................. ] 9..~.~....Permit No ............................... ............... ....................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ............... .................. ,9.::... INSTRUCTIONS a. 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 Jot 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 BuirdJng 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 ~sed in whole or in p art 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 issuanc,e of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southoid, Suffolk County, New York, end other .applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for rbmm;d'l'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 wheth,er applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. 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 w~j,ch proposed work will be d?~ne. Map No: ............................................ Lot No: .................... Street and Number ............ ~.. ............ :'. .......................................................................................................................... Municipality 2. State existing use and occupancy of p~emises and intended use and occupancy of proposed construction: a, Existing use ~nd occupancy ........................ ~ .......................................................................................................... b. Intended use and occupancy ......................... : ........................ ~, ................................. ': ......................................... 3. Nature of work (check which applicable): New Building .................... Addition ............... ,....,Alteration .................... Repair ............ .~......Removal),.~ .................... Demolition .................... ~..0. Other Work (Describe) ~.~.~.l~../.O Jn ~, J. ~ ~'~' O .~ t~. 4. Cost... :,D ~,..~...0.. ............................................. Fee. , .......................................................... . ................... : .... Estimated (to be paid on filing this ~f~,ljcatlon) 5. If dwelling, number of dwelling units ............. ~..Number of dwelling units on each floor ............................ If garage, number of cars ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............ : ................. Rear ....... .(....~..?. ........ ;... Depth,~.~....~. ................. 7. Dimensions of e/sting structures, if any: Front.......~(...c(....~:i'. ..... '/' " ' ~' ~ 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 / O O Rear ............ ./..~..(?. ..... Depth ..../...~.~.....~. ........... 10. Date of Purchase ................... ................... ~ ................ Name of Former Owner ........................................................ 11. Zone or use district in which prem'ises are situated ................. /~ ....... ~...~4....~....,~..~,...,'.~;...c;,,~. ....................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ........ ~...C). ................................ 13. Name of Owner of prem'ses/::l..'%'"'~"' .................................. ' -~' ' '" Address ../.W.~,..;..~.:M:,.~.:...:.f..-r. ............ Phone NO. . ................... Name of Architect ............................... ; ........................ Address ............................................ Phone NO ..................... Name of Contractor .................. .................................. Address ............................................ Phone NO ..................... PEaT 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 accor, ding to deed, and show stre~t~na~es and indicate whether interior or corner lot. ~ .... ~ ~,~ ~ O /~ ~ ~ cOUnTY ..... ............................................................................................... be ng duly sworn, deposes and says that he is the applicant (Name of'individual signing application) above named. He is the .................................... ~~ .............................................................................................. '. (Contractor, agent, ~orpOrate officer, etc.) of said owner or owners, and is duly authorized to perform or have pe~fbrmed the said work and to make and file this application;' that all statements'contained 'in, this,~ppIication-are true..to the best of his knowledge and' belief; and that the work w I be performed n the re.anSer'set f~rt~ in the application filed therewith. Sworn to before.me th,s .............. ~.. ~ ' ' '"'x. :.~..~ ."~zv . -. .......... [. ...... :.. day of ................. ~ .................. l~.,p~..:~,/,:~ , v ' (5g ~ t ~an~ / Nota~ Pubhc,~..~ ................. County '~' z~ ~-g ' (,,.. , ~ roi, , ~ , ;