Loading...
HomeMy WebLinkAbout6922-zTOWN OF SOUTHOLD BUILDING DEFARTMENT 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? 6922 Z Permission is hereby granted to: ..... ~me, t~e~-.Cove ..l~.:t,n~..;[ae .............. ............. l~_~a~l.~.. ~t .................................. ...................... ~.~e~...I~.l~ ...................... to .~el.... ~.. m~.. ~' emo.~.. ~xis .tiD~ ...... m~.. oo =u~an~.. b~i~.n~.. ~.~-~ ). ....a..n. ~....r...em.~ .a..~.~.. ~;t.t~b...~rxl~r.g~..~e~.l;~,~n..~w~ ................................................................ at premises located at .~..~.~...~-.~!)].~..~d ......... (1~...6.t~mai~..~..223) ......................... ........................................... ~A~he~'s...la.la~ .................................................................................. pursuant to application dated .........................J~..~:~ ................ , 1~ ....., and approved by the Building Inspector. Fee ~. ~.~ .~. ............. FOR~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUT.O,£,, ,. ¥. .... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This applicahon must be completely filled ~n by typewriter or in ink and submitted in triplicate to the Buildin,. 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 adloming premises or public streets a areas, and gwmg a detailed descnphon of layout of property must be drawn on the d~agram which ~s part of th~s application c. The work covered by th~s apphcation may not be commenced before ~ssuance of Building Pertain d. Upon approval of this opphcat~on, the Bulldzng Inspector will ~ssue a Building Permit to the apphcant. Such permJ shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used m whole or in pa rt for any purpose whatever until a Certificate of Occupanc' shah hove been granted by the Building inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Budding Permit pursuant to th, Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o Regulations, for the construction of buildings, add~tions or alterations, or f~Q~removal or demolition, as herein described The apphcont agrees to comply with all apphcable laws, ordinances, buJlaing ~ode, h9dsin~zode, and regulations, and t, admit authorized respecters on premises and in. buildings for nec~¢s~ry msp~e~ions./ / . _ . (Signature o~f~applicant,~name, if a corporation) ...~..~..E.~et~z~. Ze~t~. t~:.~m,~ ..................... (Address of applicant) State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises .... ?..~..:t~t~tJ.t.~..J~l/~.~j..~1'~.~ ............................................................................. If apphcant ~s a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No.~..~...~.~/.....~..~ ....... ~.''4~ Electric,an's License No/~....~..~.~.j...~..IK,,.....~I~ Other Trade's License No ............................................... 1 Location of land on which proposed work will be done. Map No.' ...~J...(~J~,~,~ .............. Lot No .....~.~ ................ Street and Number lla~l~ ~ F~P~t~I ~1~i~ Municipality 2 State existing use and occupancy of premises and intended use and occupancy of proposed construction: a Exisiting use and occupancy ......................................................................................................................... b Intended use and occupancy ............................................................................................................................ 3. Nature of work (check which applicable): New Budding X Addition X ................................... Alterahon' '...~ .. Repair ......X. .......... Rem~oval .....X. ............ Demolihon .................Other Work ....................... '......~. ............ (Description) 4. Estimated Cost ..... ~,l,..O.~..g..g.~.,..q.q ............................. Fee .......... ~...l:..5......o..q .............................................................. (to be pa~d on filing th~s apphcation) 5. If dwelling, number of dwelling umts ..~. ......... ..~.'. .......... Number of dwelhng umts on each floor .................. If garage, number of cars ..................... : .................................................................................................... boat 6. If business, commercial or mixed occupancy, sp~,~f¥ nature and extent of//ea~ch/type of use ...... 7 Dimensions of 9xisiting structures, Jf any: Front ........................... rv Rear ................................ "~' Depth Height ..~ ..... /...x. .......... Number of Stories .....~.....V~.....Q .................................................................................. Dimensions of some structure with alterations or additions: Front ....................................Rear .... Depth ................................ Height .....................,~:'"~:l~lumber of Stones ........../Ik;,"':~"? ............. 8 Dimensions of entire new construction: Front ..... .~'.o ........................ Rear ...... .~.....6.. .............. Depth ..'"/' ..~.. ..... . Height ......¢~..0. ....... Numberc/,4 ~f Stories ...................................... c'//I ~ ........................... ~,/'~, , (D--"f 9 Size of lot Front ........ .O...'~. ....................................... Rear ...~...~f ............................... Depth .. J .~..~ .... 10. Date of Purchase ....... ~1~,,. ]L.c~J]~ .......................... Name of Former Owner .~81~'&'~,,rl..~Jl~l.yrl~'d .............. ] I Zone or use district in which premises ore situated . "A" Dis1: (N-C "1::") 12 Does proposed construchon v~olate any zomng law, ordinance or regulabon ..... Pg. ....................................... 13 Wdl lot be regraded ..... D.~. .................. Wdl excess fill be removed from premises: ( ) Yes ( 14 Name of Owner of premises ~.;~z~j~.~.~..~...~D.V.~...~..~...n..e.~.~.I...ng~ddressF'.&.~.h..~.~.]~.~.~'.. Phone N o.5 ~ .6. .%?. .8. . .8. .': .?. .5. ~ Name of Architect ..................................................... Address ................................ Phone No ...................... Name of Contractor ..................................................... Address ................................ Phone No ...................... PLOT DIAGRAM Locate clearly and d~stmctly all buildings, whether ex~ting or proposed, and red,cate all set-back d~mens~ons fron property lines Gwe street and block number or description according to deed, and show street names and red,cat. whether interior or corner lot STATE OF NEWk-Y-OI~, ^ ~.~ ts S COUNTY OF .....,:~____~¢.~ ......... ................................. ].~.......~'..~.....~...:.~ ........ being duly sworn, deposes and says that he is the apphcan (Name of ind~wdual s~gnmg contrac¥) above named. t~l~i"~'g'~',' corporate officer, etc.) of said owner or owners, and ~s duly authorized to perform or have performed the sa~d work and to make and th~s apphcation, that all statements contained in th~s apphcation are true.~z:t.~he best o,f/h~s~ledge and behef, an~ that the work will be performed ~n the manner set forth m the applica~filed ~erewit~ Sworn to before me this .... ~~ / / Te~m ezP~es ~ch 30, 19 ~