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HomeMy WebLinkAbout5933-z FO~ NO. 2 TOWN OF SOUTHOLD BUILDING DEFARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISE.~ COMPLETION OF THE WORK AUTHORIZED) UNTIL FULL N? 5933 Z Permission is hereby granted to: · · .~o~..;[~L~n~-~ ......................................... at premises located at ..-'~e~t'~"~c{-"&"~'~0¢"~'~'e ................................................................... ........................................... ..~e~ ..................................... ~ ........................................................ pursuant to application dated .......................... ~[.~D~G-....? ......... f..., 19~...., and approved by the Building Inspector. Fee ~;]~ ~ed(,t ............ [ ' ' , Building'q~specto~ Approved ........................................ , FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 19 ........ 19..~...&.. Pemit No~...~.....~...~...~ ........... Application No. ,...~...~..~..~ ................. Disapproved alc .............................................................. . ............................. APPLICATION FOR BUILDING PERMIT : Date ............... .?...i: ......... , INSTRUCTIONS a. This application must be completely filled m by typewriter or in ink and eubi~itted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale, Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationshi~p to adjoining premises or puLl'lc streets or areas, and giving a detaded descripuon of layout of property must be drawn on d~agram whith is part of this application. ¢. The work covered bv this application may not be commenced before issuance of Building Permit. d, Upon approval of th~s application, the Budding Inspector wdl issue a Building P, ermit 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 m whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Budding Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursqant 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 demolinon, 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 in buildings for necessary inspections. / (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. :9: ........................................ : .............. ; ...... ....... ............. .......................................................................... ~amo of owner of oremls : ............................ ~ .......................................................................... ~pplic~nt is ~ corpor~te, sign~tur~ of duly ~u~orized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No,: ....... ~ ............................................. Lot No ............. Street and Number ....... ..~.t~......'~......~ ........ (~ ......................................................................... (~ ' / Municipality 2. State existing use and occupancy of premises and intended use and occ~upancy of proposed construction: a. Existing use and occupancy ............................ ~....,~, ...... ........................................................................ b. Intended use and occupancy .................................................................................................................................. 3. Nature of work (check which applicable): New Building ....................... Addition ..................... Al Repair ......................... Removal ......................... Demolition ........................ Other Work ........ ~'~ Fee .,,~,...,...;.....,.,..,....,.......,.........,...,..,,............,, 4, Estimated Cost ............... 'c~'--'~'°'~ ................. (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 .......... .~:L..~. ........ Depth ....... Height .................. .~...~. ................................ Number of Stories .................................................. ~eration....~I .......... Description! Dimensions of same structure with alterations or additions: Front ...~. ................. Rear ....... :.~.. ........................... Depth ............................................. Height .......... ~ ........................... Number of Stories ............................ . ........... 8. Dimensions of entire new construction: Front ......................... Rear ............................ Depth ..... ............................ Height ................................................. Number of Stories ............................................................................. i ........... 9, Size of lot: Front ......... !../....~,~, ...... ~ ......... Rear ............ ,.~.,lt.,..~ ............. ,Deep, th ......... ~,,.~,,..~ ............................ I--L /' I (~r-" ................ : ........... 10. [)ate of Purchase .................. Name of Former Owner ........ ~.¢.~...., ........................... 11. Zone or use district in which premises are situated ......... ~'..~.~. ......................................................... ; ........... 12. Ooes proposed construction violate any zoning law, ordinance or regulation: ........................................................... 13. Will lot be regraded ............ r~ ............... :.. Will excess fill be removed from premises: [ ] Yes [ ] No 14. Name of Owner of premises .......................................................... ~; ~.;.~..i~.;~i....~ ........... Name of Architect ................. {/. ...................................................................................................................... ' ........... (Address) hone No.) Name of Contractor .................................................................................................................... (Address) hone No.) PLOT DIAGRAM I.ocate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-b property lines. Give street and block number or description according to deed, and show street names er interior or corner lot. STATE OF NEW YO~,. ~/.~ /~/.~ ) SS COUNTY OF ........ 4~'~-. ,~ ............ ) .............................. ~..,.~.~/~///' .............. being duly sworn, deposes and says that he is the (Nar~ ~fe [nd~idual signing(c~b~ntract} He ia 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 statements contained in this application are true to the bestpf h s E6~wedg~ ~J behef and that the work will be set forth in the app(ication filed therewith. :k dimensions from md indicate wheth- applicant above named. this application; that all mrformed in the manner Approved ........................................ ~~' [ FORM NO. ! TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 19..~....~Pemit N o..~....?.....~...~... ~ ...... App,cation ............... Disapproved a/c ........ ~......~.....~, .... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This apphcation 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. 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 diagram wh(ch is part of this application. c. The work covered by this apphcation may not be commenced before issuance bf Building Permit. d. Upon approval of this application, the Building Inspector wdl issue a Building 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 Bu/Idmg Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuan6e of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southotd, Suf~oik County, New York, and other apphcab~eI Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The apphcant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit au thorized inspect~ors on premises and in buddings for necessary inspections. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .......... %..~, . .~, ........~.-~.~'..,,. ........... ,,~..~.'.~4L.;~,...k&2.~....%.~. .............................................. If applicant is a corporate, signature of du~¥ authorized officer. (Name and title of corporate officer) 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 .............. ...[~... .......... ~.Q~ ........... ........................................................................ b. Intended use and occupancy .......................................................... , ........................................................................ 3. Nature of work (check which applicable): New Building ....................... Addition ..................... Ail Repair ......................... Removalo~ ......................... Dem°.L-it~°n' ' ........................ Other Work ......... 4. Estimated Cost ............. ~...~.. .......................... Fee ..J.. ................................................................ (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 .......... ~' O De th 7. Dimensions of exist~_,~g s~,t~ctures, if any: Front ...~ ............. Rear ....~. .................. p ........ 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 ............................ Depth ..... Height ................................................. Number of Stories ............................................................. 9. Size of lot: Front ...... ~.]...~.~..~..'~ .......... Rear .......... ~.~.4..~..~ .............. Depth ..................... ~..~.[..~.,~ 10. Date of Purchase ....~¥~ ................... Name of Former Owner ............ .......................................... 1 1, Zone or use district which premises are situated .......... 6,~,,~(~,~ ................................................................. 12. Does proposed construction violate any zoning taw, ordinance or regulation: ............................................................ 13. Will lot be re~aded ................................. Will excess fill be removed frSmpremises: [ ] Yes [ ] No 14. Name of Owner of premises ,~A.5~ ,~ ......... ...................................................... · .......... ........... (Address) (Pi one No,) Name of Architect .................................................................................................................................................... (Address) (PI lone No.) Name of Contractor ................................................................................................................................................... (Address) lone No.) PLOT DIAGRAM Eocate clearly and distinctly all buildings, whether existing or proposal, and indicate all set-b property lines, Give street and block number or description according to deed, and show street names er interior or corner lot. Description): :k dimensions from ~nd indicate wheth- STATE OF NEW(~K~/A ~- ) SS '/Namd o~'ingivid 1 ~("~"""- sworn, deposes and says that he is the ~pplicant above named. ........................... f...~.~~,i~. ¢ontr.~...:i .................... being duly 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 hiflll~r)~w, tg~g(iaRd belief and that the work will be i~rformed in the manner set forth in the application filed therewith Hc, l~rl, Public. 5t<~l,~ ~[ Now Y~'rk ~ ~ ~ {/ {Signttture o~a~Pph~an FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No, ., .?. ~'..~.,~,. .............. Disapproved a/c ............................................................................................ (Buil~'~ctor) APPLICATION FOR BUILDING PERMIT Date .................. ~ ~ ........ INSTRUCTIONS a, This application must be completely filled in by typewriter or in ink and submitted tn triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee accordmg to schedule. b. Plot plan showing location of lot and of buildmgs on premises, relationsl~ip to adjoining premises or pubhc streets or areas,~'nd~l~ giving a detailed description of layout of property must be drawn on diagram which is part of this application. ~ ¢. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this apphcat~on, the Buildmg Inspector will issue a Building 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 m whole or in part for any purpose Whatever until a Certificate of Occupancy shall have been granted by the Budding Inspector. APPLICATION IS HEREBY MADE to the Budding Department for the issuai~ce 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 demohtion, as herein describe~l. The applicant agrees to comply with all applicable laws, ordinances, buildmg code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or, builder. ................................................ -- ........................................ L..,i .............................................................................. ame :f, ~:er of pre~is:s n...:.:..~.~k...~.J.~.,,~.~.,"~' '-- .......... : .............................................................................. ~fapp i an i acorpora e, ig at r of du y auth(~rized officer. ~f4 (Name and title of corporate officer) 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 useandoccupancy ............ L.~...~ ....................... i .............................................................................. b. Intended use and occupancy 3. Nature of work (check which applicable): New Building ....................... Addition ..................... iteration.. Repair Rem~jv~ ....... Demolit on .... Other Work ................... ........................ ~' ...... ~-- ~ { Description} 4. Fstimated Cost ........... ~...C~,. ............................ 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 existin/~ structures, if any: Front ...... .~.~ ......... Rear ...~....~ .................. Depth .......~..~...~.. ...... ~ .......... Height .............. ~ ........................................ Number of Stories ......................................................... ~....,~ .......... Dimensions of same structure with alterations or additions: Front ..................... Rear ........................................ / Depth ............................................. Height ........... ,..ZL/. ......................... Number of Stories ....................................... 8, Dimensions of entire new construction: Front ......................... Rear ............................ Depth ....~ ?..~..~. .................. Height ................................................. Number of Stories .............................................................................. ,. .......... · , 70 9. Size of lot: Front ...x...,LJ~..~..( ................... Rear ................ ~.f. .................... Depth,, ................................................ 10. Date of Purchase .....~... .................. Name of Former Owt~er ........... ............................................. 11, Zone or use district"/{/n w~l~lch~ premises are situated ......" ~ ' '~'....~ ..................................................... ; .......... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................................. 13, Will lot be regraded .................~....,..._~ ,Wille~cessfLll~eremov~d?ompremises: [ ] Yes [ ] No 14. Name of Owner of premises .......... ~ z ~ --n ---,~,-,jl~......,t~....~3~....._.j~ .......... ~.T..:'..'~...: ................................... ;;;£, ........................... ~'~ I {] ~ (Address~ ~ro ,ne No.) . Name of Architect .......................................................................................................................... ' ......... (Address} (Ph 3ne No.) Name of Contractor ......................................................................................................................................... ? ......... (Address) (P~ ane No.) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bac~ dimensions from property lines· Give street and block number or description according to deed, and show street names ar indicate wheth- er interior or corner lot. STATE OF NEW ~)~1~/~ } COUNTY C)F .....~.~/~.~ .................. ) 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 ~pplication; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be perfo 'mod in the manner set forth in the application filed therewith. · .......................... day of ................... ¢ . , Notary Publ .... ounty .............................. i ..........