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HomeMy WebLinkAbout574-z FOI~M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT ~.~ ~,,~ BUILDING PERMIT N.° 57t Z Dote ........... ~l~,]~j~.......~ ....................... 19.f~.... Permission is hereby granted to: ~..~....M..:....0...m.~ ........................................................ .............. ~z~r.l.~n.. I~A ......................................... ......................... ~t .$~. ~,,~k~.....g.,~Z, .................. to ..ff~;~m ..m~.. mac:L~m t,~.,t~..~.~e11.t.~.. ~ ...t,~/m...~eam~t;~ ..................................................... ot premises located at ....~,/.~.....Ii~e~..~..~'~l~'e..'~/.e;~.~ ............................................................ ........................................................... ~.t...t..$..~..~.,......~.:.~.,. ............................................................... pursuant to application dated ........ ~.~1~13~11~.....~,t ............................. 19.~.~.., and approved by the Building Inspector Fee $..].0*.00.....~l~d Approved ........................................ 19.~.....Permit No. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLDI, N. Y. Application No..,...~,,,Z., '.~,, ............ Disapproved a/c .............................................................................................. (Building Inspector) APPLICATION FOR BUILDING PERMIT vote ........... ......... .......... Ig. .:C .... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in, duplicate to the Building Inspector. b. Pier 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 shah 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 shah have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant ta 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. .................. (~ .',~.zr. ;~..~ ,¥x,-..... ~,....~, ;~ ................... (Signature of applicant, or name, if a corporation) (Address of applicant) ~.~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........................... ~5~2¢~;~5~ ..................................................................................................................................... o, ............................................................................. ff opplicont is o corpor*te, siOnoture of du{~ ~uthorized officer. (Nome and tMe of corporate officer) 1. Location of land on which proposed work will be done. Mop No: ............................................ Lot I~1o: ..~ ....... Street and Number ............... : .... "~"."~ . .......... .c.~. ~ ~: ..... Municipality 2. State existing use and occupancy of premises and intended use and ,~ocupancy of proposed construction: a Existinguseandoccupancy ...................... .J;.~..'...;~ .......... ~..'. .......................................................... · b' Intended use and occupancy ................... ~.¥. ........................................................................ 3. Nature of work (check which applicable): New Bu Id'rig .................... Add't'on .................... Alteration .................... Repair ........... .~ ...... Removal .................... Demolition ................ ~oOther Work (Describe) 4. Estimated Cost....~...O,..O.......~... .................................... Fee .../..,~..~ ................................... ','i.'..~.~i,.~ .... (to be paid on filing this application) 5. IF dwelling, number of dweliing 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 .............................. 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 ...,~..o..:;-.:.,.,.~,, ......... Depth ....~?.?:....:.~. ............. Height ............................ Number af Stories ............................ 9. Size of lot: Front ...... /....J~,,, ............. Rear ../,...IgOr... ................. Depth ,....¥..,,~....O. .............. Dote of Purchase ............... ........................... Name of Former Owner ......................... Il. Zone or use district in which premises are situated ........ .../~. ...... t.~: ........ ~ ............................................... 12. Does proposed construction ~;~late any,,,,.zoni?~ I,aw, ordinance or regulation? ..... ...~.....O. ..................................... 13. Name of Owner of premlses~:.¥.....Y..v2....L..~.Address ............................................ Phone NO ..................... Name of Architect ........... ii..~.~. ..................................... Address ............................................ Phone NO ..................... Nome of Controctor...· ........................ Address ............................................ Phone NO ..................... PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block numbers or description accordin9 to deed, and show street names and indicate whether interior or corner lot. STATE OF NE'v)/, YO~.K, ~ ) S S .................................. ..~..~'/.?..~,~ ....... '.~.~..~....[..?.~}..~.~::} ........... being du~y sworn~ deposos ond s~ys th,t he is ~he opplicont (~me o{ individuol s}~nin~ oppllcotion) obove n~med. ~e is tho .......................... ~.~2.¢.'~ ........................................................................................................ (Controctor, ~ont, corporate officor, etc.) o{ sold owner or owners~ and is dul~ ~uthorized to ~er{orm or h~w performed the sold work ~nd to moke ond file this application; that aH 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 applica~oo filed therewith. ~ Sworn to befo'e me this ~,~. [~qlS~ ~0w~ ~(~, (~ ~//' ~"~Z~ ~ ............... ~ ..... day of ...~;f:]:.:~.?.:'~ ............ I~.~...Z~fz~;';~ :~,~',',',;',;r~t~0~Signature of applicant) ~ . ~ _ ~ ~ ~~ ~. ' ;' , .,: FORI~I NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOL~ N.Y. Examined ....... [] .'-.~' ........ :.~. .......... 19.~..~... Approved ........................................ 19..~.....Perm~t No. . Application No .............. ~ .............. Disapproved a/c .............................................................................................. .............. ' ........ ..... (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 ~his 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 availaNe 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 Certificafe 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 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) /;2/ ..._' ~~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises.....~..Q,~.....~..:....~ ............................................................................ If applicant is a corporate, signature of duly authorized officer. which proposed work will be done. Map No: ..................... ~ ....... ~ .......... Lot Ng: ....']'...]].' ...... 1. Location of land on~t'~,/~ O~ ~JZ,~ -'/~ ~ ~ ]]' ~.~....c;~....~...Z St reet a nd N umbe r ....=z..~.,........,~ _.......-.,.~,~. t ...~¢.................?.....~..........~... ....... ~ .... Municipality 2. State existing use and occupancy of pr,emises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..................................................................................................................................... b. Intended use and occupancy ................................................................................................................................ 3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration .................... Repair ............ .~.....Removal .................... Demolition .................... Other Work (Describe) ~?.) '~)2 ....... o o o . l O Z.a. 4. :snmarea uost....u.j ...................................................... pee .......................................................................................... (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 business, commercial or mixed occupancy, specify nature and extent of each type of use .............................. 7. Dimensions of existing structures, if any: Front ........ ..~......~. ........... Rear ...... ..~......~. .............. Depth ....I~Z...~. ................... 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 ..... .3..%; ......... Depth ~-' Height ............................ Number of Stories ............................ 9. Size of lot: Front ...... ./.~ ............ Rear ..../..~ ................ Depth ..... ./.?'~.0. ............. / of Purchase Name of Former Owner /:=r, I0. Date ........................................................ ~" .,/73.~,, ~f'~.' ~"'7'""c;' .......................................... 11. Zone or use district in which premises are situated ........ ...... ~: .......... ~..'~ ............................................... 12. Does proposed construction v,~late any zonir~ Iow, ordinance or regulation? ...... ...~.....0. ..................................... 13. Name of Owner oF premises.~..~........P~......(.-?.~.Address'-' -- '"-- ............................................ Phone NO ..................... Name of Architect ................ ..~. ..................................... Address ............................................ Phone NO ..................... Name of Contractor ....................... ~ d c~O~...~..r,~-,' ....................... 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 'tot. STATE! OF NEW. YORK~ ) S S . .................................. L/~,-zk,~v~f~,~. ...... ~4....~,,..~,~, .......... being duly sworn, deposes and says that he is the applicant (Name of individual signMg 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 fasb in the application filed therewith Sworn to before me th s *~ p,~ " ' ' ' . ' ..-~,.-,~' ~Yo~ · · ........ ~ ~ ~ ~ ~Y ~..~' ~ :~--,,,~