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HomeMy WebLinkAbout2443-z FOItM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL cOMPLETION OF THE WORK AUTHORIZED) N? Z Date ~ 8 19....6~/... Permission is hereby granted to: iLa~,~oz~.. &. ~ea..&~e.~3~ .......................... ............ 3~-;L~[ ...... .3.~.th..S.t ............................... .......... L~;~,C~t~....~,Z, .................................... to ....~llL~..att.&dd:~.t,:~on..~r~.~n..eoc~,at~,n~..d~al3~Ln~ ..................................................... (~t premises located at ..~.....~,.e~J2~...R~.~ad...~...L, T,,~tllld ........................................................... ......................................................... .~.o.u~.~ ..................................................................................... pursuant to application dated ............................. ~'t~,~' ....... 8 ............. 19..(g~., and approved by the Building Inspector Fee $...~'..00 ............ FOEM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ../..~? .......... I .................... 19 .... Approved ~ ~ '~ ........................................ , 19 ........ Permit No ................................. Disapproved a/c ..... .~. ................................................................................. ............... ....... ....................... ......... ................................. 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 propertymust be drawn on the diagram which is part of this application. 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 o 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, building code and regulations. (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. .................. ............................................................................................................................. ofpremises ................... ~., .~..,1~.~x/ ? , ~ ~ ~ i C~ ~ ~-~, , ~ ~ ~ ~.~ ~ ...... Name of owner .~ ........................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) I. Location of land on which proposed work will be done. Map No: ............................................Lot No: .................... Street and Number .~.~.~.[~.~...~.~..~.~.~...~.~.~.~..~.~.L.~..~`.~..~...~.~.~.~.~.~..~.~..~..~.~.~.~ .... / Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ............ ) .............................~.~..)..~J. ................................................. b. intended use and occupancy ..... ~..~..t..~.~.~..~ ......... ~..~..~..~.~..J..~..~ ................................................ PLOT DIAGRAM Locate dearly and distinctly all buildings, whether existing or proposed, and indicate oil set-back dimensions fr property lines. Give street and block numbers or description according to deed, and show street names and indic whether interior or corner lot. bo Ixt ¢- \ ~ b, I-~ N ~iD ~ ~ u ff ~ / I~~ STATE OF NE~YORI(~ COUN~ O~ .~..~...~.[z.0..~,~....f S.S. ~..~.~.H..0.~.~. ....... ~:...~..~..~.,~.~..~.; .................. being duly sworn, deposes and says that he is the applicant ' (Name of Individual signing application) / above n~med. He is the ................... ~ ............................................................................................................. l .... (Cont~ctor, agent, corporate officer, etc.) of ~j~,~ owner~ and is duly authorized to perform or hove performed the said work and to make and~ ~ile this application; that oll statements contained in this application ore true to the best of his knowledge and befief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to b~fore me this ................. o, ................. .......... , ~... motory' ~ublic,~.~.~ ................... ~~~oun~. ~ · .... (Sion~turo ot opp cont) ~o. 52.0344~63, Suffolk Co~nm,ss~on [xpiros March 30, ~ 3. Nature of work (check which applicable): New Building .................. Addition .....~ ......... Alteration .............. Repair .................... Removal .................... Demolition .................... Other Work (Describe) ......... ~.. Est mated Cost .~ ~ ~ ~ ~ .I~.. .... Fee ...................... 4. ' ..... (~o be .............. I" 5. If dwel ing, number of dwel ng units ...... .~ .................... Number of dwelling units on each floor ........................ I .... If g, aroge, number of cars ................................................................................................................... I .... 6. If business, commercial or mixed occupancy specify nature and extent of each type of use ............................ I .... .... ~ B "~-O~ 7. DImens OhS of existing structures, if any: Front ...... ~ ............... Rear ....~. .................... Depth ........................ I .... He ght ~..~9~T:~.. Number of Stories ......... .~. .............................................................................. Dimensions of same structure with alterations or additions: Front ...... ..~.... ................... Rear ..... ~ ................. I .... Depth ......~...~;2... ................ Height ~......~-~¢~,.~.,...Number of Stories ........ .~ ............................... 8. Dimensions of e.ntire new construction: Front ............................ Rear ............................ Depth ............................ Height ............................ Number of Stories ............................ "' 9. Size of lot: Front ...... .~..~ ............... Rear .....~..~...'~.. ............. Depth ~,.,..,L~.Z,~ ¢~C' , 10. Date of Purchase .....................~..~...9~.....~.~...~...3,.. ......... Nome of Former Owner .......... ~...~.~.../..~....O.. ........................ ! .... ]1. Zone or use district in which premises are situated ...................... ",~4!I ................................................ ~ I 12. Does proposed construct on voate any zon n aw ord nonce or re u Ilo ~(~ . g , ~ 9 N o.~. ~...~.....~i~.~ ]3. Nome of Owner of premises~.~l,~,J~.c~l~.~..h:..,~,~,~-l~f,~Address ......... Phone Nome of Architect ...................................................... Address ............................................. Phone No .................... Nome of Contractor .................................................... Address ............................................ Phone No ................ )m zte