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HomeMy WebLinkAbout7027-z FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF: THE WORK AUTHORIZED) No. 7027 Z Date ............. i ......... ,~. CLX. .......... 1.0 ........... , 19..~.~.. Permission is hereby granted to: to ~.~..~.O.~...O.P,A..~J,n.1;oJ,~,..a....tt'~JL..C...6tt...a.toeka&e i~nea..on..N~...P.L...~ ........... ..... ........... .6.¢..~...h~ .~...w.e.e~..~..~z~..~f~.e~'e~& .............. i ........................................................ at premises located at ...~..~..e.~....~.~..~.v..~.....~...~..~,.l~...~ ............ ~',~.e..~....~O.~.~. ..................................... ............................................. ~.t..~.~..u.~t~ ....... ~:.~:., .............................................................. i ............ pursuant to application dated ........................D...~ ........ ~. .......... i...., 19~.~.,., and approved by the Building Inspector. Fee $.1...~.......C~.. ............ f Building I'nspector [ FOltM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT: TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ....... .~...~-..~...~ZT.....~'.....©. ....... , 19...~.~. Approved ............... :). ......... /....0. ....... , 19....?.~. Permit No....~....~....?...7...~,,~ ........ ^pp,,ca,on .............. Disapproved ol~....~,......~_.....~:.,i.~_ ................................................ iii'.iiiZZZ} ii .-. ............. /BuildYng I nsJ~'~o r) APPLICATION FOR BUILDING P~RMI~ o,e ................ ............... , INSTRUCTIONS a. This application must be completely filled in by typewriter o~ in i6k and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according t6 schedule. b. Plot plan showing location of lot and of buddings on premises, relat~opsh~p to adlmnmg premises or pubhc streets areas, and giving a detailed description of layout ofproperty must be drawn c/n the diagram which is part of this application.~l~ c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of th~s apphcat~on, the Budding Inspec,or w ssue a: ng t to the apphcant. Such permi/t shall be kept on the premises available for inspection throughout the warPS. e. No building shall be occupied or used in whole or in part for any purpose what,vet 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 fipr removal or demolition, as herein described. The appl cant agrees to comp y w th all opplicab e laws, ord nonces, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary mspechons. (S~gnature of applicant, or nome, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, generdl contractor, electrician, plumber or builder. Name of owner of premises .~./,,~,~/~/-.~"~:(.~"'.~..~,j-~,-I.',....~¢Z.~.~Z'f~.~.....: .................................................................. If applicant is a corporate, signature of d~'ly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............... , Other Trade s License No ............................................... ~x ~, , ,, Location of land on whic~l, rooosed work will be done Ma~ Nc~' ~'~ ' r ~'~~.~Z.~°''~t~'~ Lot N /I Street and Number .~...~;.(.z,~¢%...~.,,':c....~.~..~,"~.~ ........ ~....~.~./,... ~,~,, : ................................ ~,:!~t.,.... .. , , ~wunicipality State existing use and occupancy of p_remises and intended use.gnd; occ~u~ancy of proposed construction: a. Ex~s~t~ng use and occupancy . :r...x,. ~t,~ff~ ... b. Intended use and occupancy .................................................... .~..',,~..:~.4~, ........... z ....................................... 3. Nature of work (check which applicable): New Building .................. Addition .~ ................ Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work ..........~j~..~...~rl>:~. .................... (Des,~ption) 4. Estimated Cost ............................ ~.'~..~.~.~..:..~...D. ......... 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 alterations or additi.0ns: 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 ........... ~..~.,Z ..................... Depth ..... /.'..~....?.~....~...~...,.. 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 1 1. Zone or use district in which premises ore situated ................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded ............................. Will excess fillbe remoued from. premises: ( ) Yes ( ) No 14. Nome of Owner of premises ~...~... .~.(~.('H~-A~d r ~s Zb~.[. · .~.t..: ............. Phone N o..~...~..~ .,~..'.~.~ 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. STAT[: OF NEW,.¥ORI~, . ~. e c COUNTY OF ..~..~..~/.T~2.~./~..,......)TM ................................................................................................. being duly sworn, deposes and seys that he is the applicam (Name of individual signin~ contract) obove homed. He is the ................................................................................................................................................................................ (Contractor, ogent, corporate officer, etc.) o~ s~id owner or owners, ond is duly ~uthorized to perform or h~ve performed the s~id work ~nd to m~ke ond fi}e this opplication; thor ~11 statements contained in this opplication ore true to the best of his knowledge ~nd belief; ~nd that the work will be performed in the monner set forth in the ~pplic~tion filed therewith. JUDITH T. BOKEN No 5~.~34496~ S~folk Counf~ ~ommlsslon ~xptres March 30, 19~