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HomeMy WebLinkAbout810-z FOI~M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS F~ERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 81o Z Dote ............................. ~:~,~...~O. .......... 19~9 .... Permission is hereby granted to: .~.z...~..~..~/.,...~.,...~.....~: ......................... B~x..509 .................................................................. ~utoho Em.e,..~r~w..~:o~'k .................................. .' ....... to ..~?:~..~.,¥..?.~.~.. ?~,.~. ~.z....~!~-.~ ................................................................................................ at premises located afr~/~.~`~Vj`e~¢+~;~e~e~r~~'~ ......... OrierAt, ~e~ ~k. pursuant to application dated Atl.~..~t 20 ~o~ and approved by the Building Inspector ~/'~ Bull'~d~ng In ector FORNf NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .......... ...~..~6~...~_.. ....... 19..~.~. A~roved .......... · · · .~...?.~.~..~....~ r m it No ...... ' ..~...~/...c?. ....... (Buildin~ Inspector) Application No .........~.../..h-~ ......... APPLICATION FOR BUILDING PERMIT .................................. / ........................ ,,....¢_.. INSTRUCTIONS' a. This application must be completely filled in by typewriter or in ink and su~)mitted in duplicate to the Inspector. b. Plot plan showing location of lot and of buildings on premlses, 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. l'he work cov. ered 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 issuanoe 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 a Iterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regubtions. State/whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...,/.,.... ~...... ...... ~.,'¢,,//.~:.¢~: ...... ................................................................................................. Name of owner of premises...g;2.~/..;;~/.~;L.¢;..~;'.2 ........................................................ ; ................................................... 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. MapNo .~.~.'...~.~.~...'.:.~..~'.'~..'.~?..c.~(~otNo: ....~."'~.~'~...~:'~ ~ ~ ,~-'~ ..... ~ ~' ~-~ ......... . ~'- Municipality ~ _ ' ......... 2. State existing use and occupancy of pne~ises and in, tended use and occupancy of proposed construction: ................. ............................... a Ex st ng use and occupancy b. .t nd.d a.d ........................................................................... 3. Nature of work (check which applicable): New Building ....... ~ ........ Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated'~-~'~u~t ................. ~...~ ........................................ ~ee, _ ~, ......................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units .............. .~.. .............. Number of dwelling units on each floor .......... ./. ................ If garage, number of cars ............... /.~.~.~.'f..~. .......................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .............................. 7. Dimensions of existinfl structures, ~f any: Front ............................ Rear ............................ Depth ............................ Height ............................ Number of Stories ............................................................................................................. Dimensions of ~ame 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 Jot: Front .........~¢~f~ ....... ~ear ..~..~ ........... Depth ............ 10. Date of Purchase ............. /~ ......................... Name of Former Owner ...... ~..~.~.~.~:..~..~:~..~.~..~..~ .... 11. Zone or use d~stnct m which premises are s~tuated ...... ........... e~.-..~......~.~.~....~....., ...................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ...... :~:'.'..~ .................................... 13. Name of Owner of premises...~..~ ...... Address.. ~.~. f...~.~ ....... Phone NO ..................... Name of Architect .................................... .,~ Address ............................................ Phone NO ..................... Locate clearly and distinctly ~ ~Jldi~gs, whether existing or proposed, and indicate all set-back dimensions from property lines. ~~d block numbers or description according ¢o deed, and show street names and indicate whether interior or corner STATE OF: NEW~YOR~,/ , t_) S S COUNW OF ' , \ ,~,:. ~/~..,~ fx)~ c,,,~/~/.~.~..~.£,~l~; z~./bena du~sworn de osesandsa s that he is the applicant ....................... x.~..~....~.~.,.~ .................................... r....,- .... p y (Na~e of individual signi~ applicgtion) ..... / ~ above named. He .s the .............. ~.~W[..~.....~.,k ........ ~.": .........'"". ................ : ............. ~ ........................................ / /(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 wiJl be performed in the manner set forth in the application filed,ther~w~, ,u, Sworn to before ~e this ~ ~' L~].] ~ ~/~)~l~ /,.,~ 6~.. ~f C~¢ r~'¢~..,~"~ JUDITff T.' ~ (S ~nature of app cant) .............. -~"~'"'~"~"' ;'"v2"~;~ ' ~ ....... 7"'~ot~r~ Public, Star, of New Yo~ . ~.~ ~~ ~; No. 52-0344963. ~uffolk Cou,~ty .. Nota~ Pubhc, ~ ........... ~.;.~.~..~.~.~ ~;n~ss~, ~pi~s ~ ~ ~f ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examlned ............. Approved ................ ~ .......... ~..19.....~../~rmit No......~.~...~..../'...~.. ........... Disapproved o/~ ................................................................ ........ (Building Inspector) Application No. Z/c/") APPLICATION FOR BUILDING PERMIT o,e ........... , ........... 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 adjoinin9 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 p art for any purpose 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 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 a Iterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. ignat.u~ 9~'glCplicont, or name, if a corporation) ............................... State,whether applicant is owner, lessee, agent, architect, engineer general contractor electrician, plumber or bu der Name of owner of premises ............................................................................................................... [f applicant is a corporate, signature of duly authorized officer. (Name and tide of corporate officer) 1. Location of land on which proposed work w. II be done. Map NoJ~r~...~.~ _~..;.q..~.~....~ot No: ......~.. Street and Number /~/~' ....................................~"; ~ Municipality .............. .~¢ t,~.4~z~. ...... r.~/r..~ ...................................... 2. State existing use and occupancy of premises and intended use and occ6pancy of proposed construction: a. Existing use and occupancy ............. b. Intended use and occupancy ......... Locate clearly and distinctl property lines. Giye street and b whether interior or corner Jot. ' 3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration .................... Repair ................... ~,~ ,-~ ~ e~,~"Rem°val .................... Demolition ....... ~, ......... Other Work (Describe) .................... 4. Estimated Cost........'~.......~..)....~........~.... ................ Fee ../..t~...~ ....................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............. ../'... .............. Number of dwelling units on each floor ......... ./. ................ If garage, number of cars ............... ~..~.....~..~.. .......................................................................................................... 6. If I~usiness, commercial or mixed occupancy, specify nature and extent of each type of use .............................. 7. Dimensions of existing structures, if any: Front ............................ Rear ............................ Depfh ............................ 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 .....~Z ........... Height ............................ Number of Stories ......... ~.. ............... 9. Size of lot: Front ........ ../.~..~....~.. ........ Rear .../..~..~. ............ Depth ....~...-~..~.~...~-- 10. Date of Purchase /~... ..................... Na~e,~;~ ,~,~ ~,-/~,/'~/,~~°~f Former'Owne'r ' ..~.,.<~...~.t~-..~:~../~.,~..,c'-'-'-'-'-'-'-'-'~., 11. Zone or use district in which premises are situated ...... ,C;~......e.'~,~e~...4r,./~......~,¢...~..':~-~...: ...................................... Does proposed construction violate any zoning law, ordinance or regulation~" ..... ~. ..................................... 12. Nome of Owner of premises,..~/..~..¥.~......,Address~ ' z/ ~-~.--~ ..... .~..~i.~.,~ ........... Phone NO ..................... 13, Name of Architect .................................... ~ ................. Address .....; ............ .~ ............. ; .......... Phone NO ..................... i /~/~'/"~"~/-~'//~-~ Address ~.Z...~. ~"...~.~ /~' .~.. ' Phone NO Name of Contractor.~t'/~'~...~ .......... ~.~.:.~' .................... ~,, ........................... 7~ ............................. uildings whether existing.or proposed, and indicate all set-back dimensions from ack numbers or description accbrding to deed, and show street names and indicate /00 COUN 0 ~.~ '. ...................... ,~.,,~'..,~._~.~:.~.,....,..,~. ,.~,,,~,,~/,,.~.,,fi,,~,,.,,~,,.,,,~,,. being duly sworn, deposes and soys 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 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~_,ther~wi~ Sworn to before me this ~ j ' ~ ' ....... ~, ~o~ of .~ .z;.~~.~r ~um'r, r. ~n~re .................. . ..... ~..~ ...... / n~ y uH~c, S~ate ~/~w Yor~ ss~on Expires ~a[~h ~0~ ~9~/ .