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HomeMy WebLinkAbout458-z FOI~M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 1,'ol 0 BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 458 Z Dote ...... ~eP~;~r.....24 .................... 19.~.~... Permission is hereby granted to: Fred Plate A/C.....A.E~Budn~ ..................................................... ....... Sig. s b.y..~l ................................................... .................... ~¢~.t.t Ltuek ....................................... to ......... ,~ld..~tl.. add.i.tion..on..e~a...exist~g..,dw~lli~ ................................................ at premises located at -'Sl~8]~y...pO~d ................................ : ................................................................ .......................................................................... ~atti.tuck,.....~.[o.~:~ ................................................. pursuant to application dated .................. ~,P.~.~,.r~b~....2~. .............. 19.~.., ond approved by the Building Inspector F~e $ ~'.:..0...0. .............. FORM NO. 2 TOWN OF SOUTHOLD $OUTHOLD, N, ¥. ~~'~UILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 458 Z Permission is hereby granted to: :~ed Plate A/Q.....~,.,E,~?4.~,o ..................................................... ........ ~.i g,~by***P,.cl. .................................................. ..................... ~a.t.t i.t. uck ...................................... to ........... B.~.Z.~,..~.~...~.~..t..o.~...~.~...~...~.~.~,~.~.~ng...d~e],~.~,~ ............................................... at premises located at ...S;[4~S.~...~.O~ ................................................................................................ ........................................................................... ~t.~.$.C.~**c~.,....N.,.~.~. ............................................... pursuant to application dated ................... ..~..~.~.~.e...~.~..~.......~..br.. ............. 19..~...8.., and approved by the 13uilding Inspector Fee $..~:..o...o. ............. Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFEICE SOUTHOLD, N. Y. Examined ........................................ 19 ........ Approved ........................................ 19 ........ Permit No ............................... Disapproved a/c .............................................................................................. Application No ............................. (Building Inspector) APPLICATION FOR BUILDING PERMIT Date .............. ....... ....... ..... 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 lot 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 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 ~r in part for any pukpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuonee 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, os 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 premL~, ~.. t. .............. ~...: ............................................................................................................. 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: ............................. Z ............. [~ot No: .................... brree~ aha mumDer .....~.~.r ....... [ .......................................................................................................... Municipality 2. State existing use and occupancy of p~emi~s and intended use and occupancy of proposed construction: b. Intended use and occupancy ............................. ~.'J ............................................................................................... 3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost.....~.~......~.....O....~ ................................ Fee .~...:~' ............................................................................ (to be paid on filing this application) ,5. If dwelling, number of dwelling umts ........ ~ ..............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 .............................. 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 ............................ Depth ............................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises ore s~tuoted ........~...~......~.~...... ........................................................ ]2. Does proposed construction violo~o ony xonin~ law, ordinance or rooul~tion¢ .................................................... 13. Name of Owner of premises.g..t.[,....~~Address ~.~.;.~2.~L..~hone NO ..................... Name of Architect ........................................................ Address ............................................ Phone NO ..................... Name of Contractor..~.....Z~.~ ........ Address ............................................ 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 Iot. STATE OF NEV~-~YOR[I~,~' ,~1(.~~,~,_,~,,~ ) S S ....... . . . .... f;/.. .... ~....~ ~ ..................... being duly sworn, deposes ond 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 .....'~''..~.~....~. .......... day of .....'""~ '~ ..... 19....'~....~.. ,~?ature of applica~:~,G----~ , Notary Public,. ........................................................... County ~///~'b~~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOL~ N,Y. Examined ........................................ 19 ........ Approved ........................................ 19 ........ Permit No ............................... Disapproved a/c .............................................................................................. Application No ............................. (Building Inspector) APPLICATION FOR BUILDING PERMIT 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 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 I~ept 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 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. ...L.. :. :...~:':...::.~ ........... ~].~'..57...:..>..~: ........................................... (Signature of applicant, or name, if o corporation) .. >.K...'.~... ~.: .&.~, .. ] ............. ..~..(:~...t::t .................... : ...... : ............... ' (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of prem 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: ............................................I~ot No: .................... Street and ~umber ........ , ...... ~ ............~ ............................ Municipality 2. State existing use and occupancy of pr,emis~s and intended use and occupancy of proposed construction: a. Existing use and occupancy .................. b. Intended use and ~cupancy .............................. ~ ................................................................................ 3. Nature of work (check which oppllcable): New Building .................... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition ................... .~)ther Work (Describe) .................... · ?~ ~ c> ~ '~ °"~' 4. Eshmated Cost ......,.....~. ............................................... Fee ........ :T.:.~.~. ........................................................................... (to be paid on filing this application) 5. IF dwelling, number of dwelling units ......... f~.~ ...... 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 .............................. 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 ............ ~.L..~,::.. Rear ..... ~..'....6.'. ......... Depth ..,~.-~'~...~..~..:; ........ Height ............................ Number of Stories ....(~;~...~.:..~,,,,~ .... 9. Size of lot: Front ............................ Rear ............................ Depth ............................ 10. Dote of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ........ ~..Jf~...,.~.z~.~',,.~ ......... t:~>..~.>.,,,~, ........................................... ]2. Does proposed construction violate any zoning Iow, ordinance or regulation? .................................................... 13. Name of Owner of premises..,/A....~.:....,~w,,e-~,~.,~:.Address I...~..~.t...:.]2..~.~.......~...:~.~..¢.'::,,.,,Phone NO ..................... Name of Architect ........................................................ Address ............................................ Phone NO ..................... Name of Contractor../.d~.,},....../:~L~.,~..4.,,,d~,~. ........ Address ............................................ 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. STATE OF NE~,YOP~,~ ~ ) S S ................................ ~. ............. ~.....:: ....... ~......'.' ......... '.....:..: ........ being duly sworn, deposes .and says that he is the applicant (Name of individual signing application~ above named He is the ................................................ ........................................ of said owner or owners, and is duly authorized to perform or hove 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 ....~'.~..~4 .~.~:~ ....... 19~.~] ~ature of applica~, ~ .......