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HomeMy WebLinkAbout3667-z FORM NO. ~ TO~VN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERMIT CT'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 3667 Z Permission is hereby granted ~o: ............... ~ ~..~.~.r. ~....~.~,~m4 .............................. to ~ =~u:l..z~e~..c]~t, ec~e~..p3~wt, e,..~,r&S$ ......................................................................... at premises located at ~,~...~,~r;LE...~.~,~iJ,I~I~ .............................................................................. ................................. _~,~;.. Zr,~tt .....]/~:. ............................................................................ pursuant to application dated ............................. ~i~-.~ .............. , 194~.., and approved by the Building Inspector. JJ~j ~ ~0 ~ 3~ I1~ br~ ~ JJ~SJ~lJ~ ]*~Bds e ~ ~ ,Fee $.~a~.Q ............. Building Inspect~ F~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. /~amined ........................................ , 19 ........ ;proved ......... ........ , 19....~.Permit Disapproved a/c .............................................................................................. ' (Building Inspector) APPLICATION FOR BUILDING PER~v~IT 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 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 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 alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, or_eli,nonces, building code and regulations. (Signature of al~licant, or name, if a corporation) .................. (Address of applicant)k) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner at premls .............................. (~:..,...'.:.~. .................................................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) , -,. ¢~4','.f(~ q 1. Location of land on which proposed work will be done. Map No: ............................................-at No: ................... ? Street and Number ...................................... .-~.~.,'~......~,'k,~.~.,.,~..,c~..~...~.'b~. ......................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..NJ....~...~ ~...~..~ ................ ' '. b. intended use ond occupancy ................ .?..~..~ .................................................................... 3. Nature of work (check which applicable): New Building 1"/ Addition Alteration Rep ~ir .................... ~ ,_ ,,-Rem°val .................... Demolition .................... Other,,__ ,~:__ ~o Work ~(D~scribe) .................................. 4. Esti,nated Cost ..~,...~.~.~..'.:fl...q.,9 .......................... Fee ............... ..d~....~..?.......~....~...O...r.:,..~.... .................... (to be paid on filing this application), If ghrege, number of cars ....................................................................................................................................... 6. If l~usiness, commercial or mixed occupancy, specify nature and extent of each type of use ........................... 7. Din msions of existing structures, if any: Front ........... ~;T.. ......... Rear '-~ Depth Hei ht ......... ~ ............... Number of Stories ........................................................................................................... Din msions of same structure with alterations or additions: Front ~-~ ................................ Rear ............................ Del: h ~ Height ........... ~ ............. Number of Stories 8. Dim'ensions of entire new construction: Front ~'f-'o" ' 0" ........................ ............................ Rear .... .~.~. ................. Depth ' Height ....... .,7.~..~;~..q...~..~ Number of Stories ....... ~ ................ 9. Size! of lot: Front ............................ Rear ............................ Depth ................................ 10. Dot~ of Purchase ...........~.,...~..~.../..?...~...~l ............ Name of Former Owner ...-~.~...~.~ 11. Zonle or use district in which premises are situated ....... .~..~_.,.~..~.(.~./.~. ..................................................... 12. Doej~ proposed construction violate any zoning law, ordinance or regulation ......................... 13. Nonhe of Owner of ......~'Zlf~....~..'...gg...,~...~..Address. Phone No. ?..~.~..~... ~.~ Nar ~e of Architect ......~....~ .................... Address ~.....¥~....~ ...... Phone No ................. No, ~e of Contractor .~.......%...~..~......?.,..¥.....~.. ....... Address~.~r~.~..~...~..... Phone No.2~..~..?..~ PLOT DIAGRAM Locat ~ clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions fn property Ii ~es. Give street and block numbers or description according to deed, and show street names and indic~ whether in 'erior or corner lot.  L°~ m...1 o STATE OFJNE~,V')YQR/<,: ~,, ] ~ c COUNTY pF .~.~ ........... f °'°' .......... O~[~J J J I J J'~ ~ J ~J JJ~ J~ ~ ................................... be.rig duly sworn, deposes and says that he is the applic(' (Name of individ(~!,~l, ication) above narded. He is the ...'~r~ ............................................................................................................................................. i (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 this applici~tion; that all statements contained in this application ,are true to the best of his knowledge and bell and that t~e work will be performed in the manner set forth in the application filed therewith. Sworn to b'e~ore me this r~ , oro y ,u, .......... County (S:gnature of opp::eon / Te,m o~mhe~ ~/iarch 30, ~9 !