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HomeMy WebLinkAbout2966-z FORM NO. 2 TOWN OF SOUTHOLD DUILD~NG DEPARTMENT TOWN CLERICS OFFICE SOUTHOLD, N. Y. (THIS PERMIT MUST BE K[:PT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 2966 z Building Inspector ~0 Fee $..~.~.~. .............. Permission is hereby granted to: · .~.~e~.~&ng...~..~h~.~¥~,.~...~e ........ .............. ~ ~a;t~acq~t,.&'~ .................................. ................... ~z:.e. er~l~Or.l~. ................ to ~z,~e ~... a~d.. ~a¢. n.~, ai~.. ~.. ~z, e~me~ ,. ~ g~.. ~+,~...X.. 8~.t ........................................................ at premises located at ...,~,t/.~.....}.~h~.~..~V,....:.'~ ......... ~....;,...x~L ............................. i ............... ,~Z~ee~, ~:...~.~.,~.~ ................. ,..,..~ ............................ , .................. pursuant to application aated . ....... FORM NO.I 'l'~,WN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ................... ; .................... , 19 ........ Permit No......c9 ....... '/............C~ 6 .... ~ Disapproved a/c .................... {Building Inspector~ ............................ APPLICATION FOR ~ PERMIT Application No. ~ 2 C~ INSTRUCTIONS o. 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 descriptiqn of layout of property must be drawn on the diagram which is part of this application. c. The work covered by this application may not be commenced before issua.nce 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 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, 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. ......... ............................................................................................................................................ Name of owner of premises ...~...~.~.~. ~...C.~......[;!j~.{~.h~-,.~.~;.=......~Z'.).~.~:( .M'.,c~ ....... ,..~g ........................................................... If appli~nt is a corporat~ signature afl ~uly authorized officer. ........ ........... (Name and title of corporat~ ~fficer) 1. Location of land on which proposed work will be done. ,Map No.' ........................................ Lot No.: ........................ Street and Number Municipality 2. State existing use and occupancy of premises 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 B~'.-'M.a .................. Addition .................. Altera.tion ......... '~ ........ ' Repair .................. ,Removal .................. Demolition..... ....... Z, ..... Other Work (Describe) ........................................ 4. Eshmated Cost .... ~ ....... ~ ........................................... Fee ........~.~ ............................................................................. (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 .................... Height ........................ Number of Stories ........................................................................................................ -..~ ...... Dimensions of same structure with oJterations or additions: Front .................................... Rear ............................ Depth ................................Height ............................ Number of Stories ................................ 8. Dimensions of entire new ~: Front .................................... Rear ............................ Depth ....... ~ ............. ~ ....... ~. .........Number of Stories ...................................................................................................................... 9. Size of tot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ........................................................Name of Former Owner ........................................................ 1 1. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ........ ,~ ............................................... 13. Name of Owner o~ premises ........................................ ~aaress .~z~:.m-~4.....z.~.~.' ............ :... Phone .................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .................................................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly ~11 buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, / e e C..~_NTY OF ......~) .................. .J..~ .... above named. He is the ........................ : ............. : .............. 'r; ...... .~ ................... .,~..~......~/..~ ........................ : ........................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the seNd work and to make ond file this application; that ail statements conta:ined in this application are true to the best of his knowledge and belief; end that the work will be performed in the manner set forth in the application filed therewith. Sworn~'/t° be.~e me this ~~..---~'/~ -- /c-- ~-?-'~ / ~ , ~ ' ¢2~,/.. d y of , 19 Notary .............. ........................... MARGERY D. ~IURF. IS / / / ' Nota~ Public, State of New Yolt / FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ~x ~ _ ........................................ , 19 ........ Permit No ................. Application No, c~ 7 ~ ~ Disapproved o/c ................................................... :~:.~,,,~ ...~.. ...... :L~::~ ........... ... APPLICATION FOR ~ 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 deCailed description of layout of property must 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 sha. II 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 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) /~/~' ?~- z~' ~ ""'~ ~- ..... ~.'c~.t~.~.s.~.~.....~:.~T. ....... ~?:~:,.~?.~.~r.....~..!:.:..L:...~.'.~J..: (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner ~. r,~-,.~, .......................................... , ...................................................... ,,...-., .......................................... If a~cant is a corB6rate, signatg[e of duly authorized officer. ..... ....... ................................. (Name and title of co~mte officer) 1. Location of land on which proposed work will be done. Map No.' ........................................ Lot No.: ........................ Street and Number .~..~.~.~.~z:~ ........ '..,ag..; ....... ........................................................................ Municipality 2. State existing use and occupancy of premises and intended use and occt~poncy of propos~ construction: =. ~xi,ti,g ,,e ~nd o~pa,~y .............................. g~.~' .......................................................................... b. Intended use and occupancy ................................................................................................................................. 3. Nature of work (check which applicable): New [],~Jim~ ...~..~'..~ .... Addition .................. Alteration .~. ............... Repair .................. Removal .................. Demolitioq ................. Other Work (Describe) ........................................ · 4. Estimated Cost ........... t...'2..~.)...Z.. ................................ Fee ............ ~.....~,..' .................................................................... (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, Jf any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ ~,e*~ - 8. ~ime. ns OhS of ent re new-rdldlJl/i/dmm Front .................. Reor ............. Depth ..... Ce:t~T~ ~" .................. 1~ ............. ?. ..... Number of Stories ...................................................................................................................... 9. Size of bt: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ...................................................... i. Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? .~..~.~ ........................... 13. Name of Owner of premises ~.t..e~..~/H.q'....d~'t~..A...i~ZYe.'.t~,~,'ddress ....W]..!~.~..~t.~ .~.~?'*( ....... I{~,~Z ...... Phone No. ~...~..:.~..:~? Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .................................................... 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 number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, COUUTY OF ........................ ~ ...... ,f .... ...... !.~..~......~...'....~... ............................................. being duly sworn, deposes and says that he is the applicant (Name bf individull~rl~igning application) above named. He is the- ',LJ~.~..~.-.$L~t<~..T ............... .~..~..~..L~!..~..~.-:.. ...... k~.~, .~.~.....Y~.. ...... .~.Z~J.~/.~.(Z...0 ...................................... (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 oil statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed~the manner set forth in the appI. Lic.~tion filed therewith. Sworn tnbef~r~ me this ...... ....... o, ...?.... ........... ' ..... ............................ ~o. s2-05o~ s~ffo_~ c..~.~/~ / / / '11 , T, orm Exp~es March 30, 1~,~7 ' / '