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HomeMy WebLinkAbout6107-z i BUILDING PERMIT (THIS PERMIT MUST gE KEPT ON THE P~,EMISES UNTIL FULL COMPLETION OF THE ~WORK AUTHORIZED) ~N? 610T Z Permission is hereby granted to: at premises located at ...................... ; .......... .~..~.~..~. ..........~..,~. ...... .~.,c,C .................. .......................... t.i~ ............ ~ ......... ~.~: ............ ~ ........... ~...~.~ ................ pursuont to opplication doted ............................. /.~.~. ...... 19~.,~., and opproved by the Building Inspector. Fee ~.: ................. Building Inspector FORM NO. 1 TOWN OF SOUTHOLD ' BUILDING DEPARTMENTi TOWN CLERK'S OFFICE~ ApprovedEXamined 19..~.....~.. ~emit19 ........ No.....................................~ / ~ '/Z~ Application No ............................ .............. .................................................... Disapproved .............. .................. (Building Inspector) INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and ~ubmitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Pict plan showing location of lot and of buildings on premises, relationshi@ to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on diagram which ~s part of this application. c. The work covered by this application may not be commenced before ~ssuance df Building Permit. d. Upon approval of this application, the Building Inspector will issue a Buiidin§ Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout 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, Suffotl~ 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, housing code, and regulations, and to admit authorized inspectors on premises and m buildings for necessary inspections. (Signature of appliC'Jnt, or name, if a corporation) .......................... (Address of ap, p,p~?~ant~// State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........................................................ ............................... , ......................................................................... Name of owner of premises .................... .,~..~..~'Z?....~.~ ....................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. ~r~ttl~dOfNl~db~)rn ,~,~..c~.p~..p./~sed ~..~.r.o.k..~.l, be ~..e2.M. ap No: ........ i ....... ~, L~°t~..~,'~'~"i'~;~'"/'"'(" ...................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ........................................................ .i-/ ................ ~ .................................................. b. Intended use and occupancy ......... £~,~.. ./...'.~. 3, Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration .............. Repair ......................... Removal ......................... Demolition ........................ Other Work ..... /L/.c~..~._ ........ (Descripti)n) 4. Fstimated Cost ..........~. .................................. Fee ................................................................................................. {to be paid on filin§ this applipationl 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 usa ...................... ~ ............. ~._ / -- / -'6 / ' 7. Dimensions of existing structures, if any: Front ....... ,~2..'.~..,... Rear ......... ~..~.~ .......... Depth ......... ~ ....................... Height ................... Z~....~.. ................................ Number of Stories ..................................... Dimensions of same structure with alterations or additions: Front ...... ,~ ',~..~....~,.... Flear ......... .~..~,~..xe;?, ............ Depth ............. ~.~.~.,f~,.¢~ .............. Height ........... ,~i..,:~....~....~ ............ Number of Stories .........,~...?;,,.,./~...X ........... 8. Dimensions of entire new construction: Front ......................... Rear ............................ Depth .............................. Height ................................................. Number of Stories ....................................................................................... 9. Size of lot: Front ,/,,.O O / / , ~ .5~ '~ .................................... Rear .......... ./...~...,o, .................... Depth ............................................ Height .................................................... Number of Stories ..................................................................................... 10, Date of Purchase ........../.,.~'../..../.,~..~.. ..... 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. Will lot be regraded ........ ~ ......... ;~ ....... Will excess fill be r. qmoved ~rom p. re. rnises: [ ] Yes [/%'I" I~ o 14. Name of Owner of premises .~..~J. ......... .~'~. ~2/¢¢,~...--~z. ¢'Z/~ ......... .J...~..~.f ..~..~..~.5 .....~..¢..~..~......~........~ ~ .~..'~. 7~ .~ -- (Address) (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 dimel ions from property lines. Give street and block number or description according to deed, and show street names and indic~ te wheth- er interior or corner lot, STATE OF NEW YO.J~K,f~ ~ I ) COUNTY OF ..........~....?~.-~... L[..~.. ................ ) being duly sworn, deposes and says that he is the applicant; )eve named. (Name o~ i~di~id~¢l ~i~ning contract) He ~s the ............................................... (Conttactor,'~gent, corpot¢t¢ office~, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this applir statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed set forth in the application filed therewith. TERRI LEE EL^K ...................................... C~A~f¢ .p{~ B UO;. St~t~..cl..:,i~.fv. ¥0tk ............. , 19 ............. , ,,~T~ \ (Si'~ature of applicant) ation; that all the manner- FOI~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPART/~ENTi TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ~ , 19,....,.-~'' ^ppraved ........................... :.,.., ............................ -- Disapproved a/c ........................................................................... (Building Inspector) APPLICATION FOP, BUILDING PIERMIT ~)ate INSTRUCTIONS Applleatio~ No ............................... .~ a. Th~s application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with~ 3 sets of plans, accurate plot plan to scale. Fee according to schedule, b. Pict plan showing location of lot and of buildings on premises, relationship to adjoining premises or pubhc streets or areas, and giving a detailed description of layout of property must be drawn on diagram whiCh is part of this application. c. The work covered by this application may not be commenced before issuance df Building Permit. d. Upon approval of this application, the Building Inspector wdl issue a Buildin~ Permit to the applicant. Such permit shall be kept on~ the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose w[iatever until a Certificate of Occupancy shall have been~, granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuanc~ of a Building Permit pursuant to the Building Zone~] Ordinance of the Town of Southold, Suffolk County, New York, and other applicable ~.aws, Ordinances or Regulations, for the construction o~fv buildings, additions or alterations, or for removal or demolition as herein described. Yhe applicant agrees to comply with all applicable laws~/ ordinances, building code, housing code, and regulations, and to admit authorized inspectgrs on premises and in buildings for necessary inspections. ' ISi~plicaX~, or name, if a corporation) ................... IAdd ss of a?p icant) / State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........................................................... ........................................................................................................ Name of owner of premises ..................... ...~...,.~...~..~ ...................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Municipality 2. State existing use and occupancy of premises and intended use and occdpancy of proposed construction: a. Existing use and occupancy ................... ~ ............... ~ ............ , ......... ; ....................................................................... b. Intended use and occupancy ............. ..~. :~...~:.2 .Z~ .~..'...~../.'...-~...~- ............. ~...~.,. ................ Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration. Repair ......................... Removal ......................... Demolition ........................ Other Work ....... .~...~..~...~...ll ( Descripti Estimated Cost ................. Fee ........................ ..~... ...................................................... (to be paid on filing this application) If dwelling, number of dwelling units .................Number of dwelling units on each floor ........................... garage, number of cars .............................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ....................... Front ...~ ........ Rear ...... ~..~.. .......... Depth ...... ..~.....~.. ...... 7. Dimensions of existin[I structures, if any: Height ............ --~'°~..l[....~.. ................................... Number of Stories ................ L ................................................... Dimensions of same structure with alterations or.~l/;2ditions: Front ..... ~ Rear .......... .,~lJ~... l~ ....... r Depth ...... .~1.~ ............... Height ....... ~..1~ ....... Number of Stories ....... ,1~.~ .... )ove named. ]tion; that all the manner- 0 8. Dimensions of entire new construction: Front ......................... Rear ............................ Depth ................................ Height ................................................. Number of Stories ........................................................................................ 'gh ~__ ..~...j ' He~ t ............................ Number of St .............. ............... Pries ....................................................................... 10. Date of Purchase ....... ~B/I~..~. ......... Name of Former Ow~r ......... lil~.~,~:'~..~.~ ...................... 1 I. Zone or use district in ~hic~ premises are situate .......................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .............. ~.~ .................................... 13. Will Iotberegraded .......... .~Z ~ ~ ---- --~ , _.,. ~ .-- ~. ----Will excess fill be rem°ved fr°m"remises: L] Yes ,. O e. ~ ~- ~ (Address) (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 dimel ions from property lines. Give street and block number or description according to deed, and show street names and indicJ te wheth- er interior or corner lot. COUNTY ................ ~¢:'~ "' f"~&A I )¢ /.t ¢ being duly sworn, deposes and says that he is the applicant , (N~e of #~di~i~u¢l si~nD~ co~tr~ct) ,o ....................... .... of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this applic statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed set forth in the application filed th~t~E ...................................... day of .ou~ ~ee.~..S~[~..C~un~':....'L...:... 19 ............. Notary Pubhc ...................................................................... County .................................... (S~na~re o~ applicant)