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HomeMy WebLinkAbout6505-z FO~ NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.. Y. J BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6505 Z ,~~e'rrflission is hereby granted to: ~' ....~ ~W.,.Smi.th..~..$.on~.. In~....A~C..~e~ma~ne Little .................. ~ma~J~o-~ ........................................ to ...~.e~t.. az~L., m~ ~t~,~m,..£anee ..... ( -~ea ~,-.ye~,dL--. £~)~--.-~ eg-) ........................................... at premises located at ..... .,~..0..~...~. .............. ~.Ol~l.~h~OO~[ ...................................................................... ....................................... ~,eanh~oo~L..~z~e ........... ~So~e.3.d ........................................................ pursuant to application dated ..........................~.~.~ ....... ~.~. ...... , 19.~3.., and approved by the Building Inspector. Fee $....-1,.~ ,00 ........ Examined ..... E~.....~..~! ........... , 19..~.,..~. Approved BUILDING DEPARTMENT /., ~ TOWN CLERK'S OFFICE ~" ~pplication No ............................... Disapproved a/c ..~ ............................................ (Build,rig I nspec~-~i~ APPLICATION FOR BUILDING PERMIT Date .... ~....~.,'. ................................, 19.Z~.. INSTRUCTIONS a. This application must be completely fdled in by typewriter or in ink and submitted in triplicate to the Budding Inspector, w~ 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 pubhc streets or areas, a g~wng a detmled description of lavout of property must be drawn on d~agram which ~s part of th~s apphcat~on. c. The work covered by th~s apphcatJon may not be commenced before ~ssuance of Building Permit. d. Upon approval of this apphcatlon, the Budding Inspector will issue a Building Permit to the apphcant. Such permtt .shall be kept the premises available for inspection throughout the work e. No budding shall be occupied or used m whole or m part for any purpose whatever until a Certificate of Occupancy shall have b: granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Budding Department for the issuance of a Building Permit pursuant to the Building Zo Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construct~or buildings, additions or alterations, or for removal or demolition, as herein described The applicant agrees to comply with all applicable la~ ordinances, budding code, housing code, and regulations, and to admit authorized Inspectors on premises and in buildings for necessary mspectlm (S~gnature of apphcant, or name, ~f a corporation) (Address of apphcant) State wh~t is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build= Name of owner of premises .~ ..... ,,~------~.~~ ..... ~ ........................................................ If applicant is a corporate, signature of duly authorized officer. CName and title of corporate officer) Builder's License No .......................................................... Plumber's Lmense No ......................................................... Electrician's Lmense No ..................................................... Other Trade's License No ................................................... ' 1. Location of land on which proposed work will be done. Map No ............... .,, .............................. Lot No ........................ Street and Number .~u~,~,~-...;...--_,~. ..... ~~_.~...~~--~,~....,.~I.Z ......................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... ~.~. ....................................................................................................... / use and occupancy ............ ,~.~ ........... .~...~.~....~.~. ................................................................. b. Intended 10. 11. 12. 13. 14. Nature o1[ work ~(check which applicable): New Building ....................... Addition ................. ...~=_~eration .............. Repair . ........................ Removal ......................... Demolition ........................ Other Work ..: .T.,~' .... t.~....~....~.~,,~ ~ ~ ~ (Description) Estimated Cos .................................... Fee .......... Z'....~..~. .............. ~ .............................................................. (to be pa~d on flhng th~s apphcat~on) If dwelling, number of dwelling units .................Number of dwelling units on each floor ........................................ If garage, number of cars ............................................................................................................................................ If business, commercial or mixed occuoancy, specify nature and extent of each type of use ..................................... Dimensions of existing structures, if any: Front ;~.. Rear ........................... Depth .....~. ............. Height .... ~;.~. .......................................... Number of Stories ............................................................................. Dimensions of same structure with alterations or additions: Front .......................... Rear ........................................ Depth ............................................. Height ......................................... Number of Stories ....................................... Dimensions of entire new construction: Front .... .-~..~.~.y,..~.,.. Rear ............................ Depth ....~ .~..~ ........... Height .... .~....'.~.. .................................... Number of Stories ........................................................................................ Size of lot: Front ..(...~..~.,....?...~. ................ Rear ...i..~.~.~./.."...,~. ...................... Depth ../..~.~..'.,..-... ..... ./...~...c. .................. Date of Purchase ..................................... Name of Former Owner ........................................................................... Zone or use district in which premises are situated .................................................................................................... Does proposed construction violate any zoning )aw, ordinance or regulation: ...-.~,2,~ .............................................. Will lot be regraded _,_'27~_~ .......................... Will excess fill ~ removed from premises: [ ] Yes [~-]-No Name of Owner of premises~;~¢~..~...~ ...................................................................... (Address) (Phone No ) Name of Architect .................................................................................................................................................... (Phone No.) ~l~_. /// _ ~"~_-~-~ ~:~ C(Address) _ · Name of Contracto[,,~z~.....C-~..~..~,~.~.~..~.,~.,~,....~,..--,~,.';t',~ ..................................... .7..~..~...~.,,~..~..(~:.~ ........ (Address) (Phone No ) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fro~ property lines. Give street and block number or description according to deed, and show street names and indicate whetl er interior or corner Int. STATE OF NEW yC)RK, COUNTY OF ... ~ ~J...~,.-~.~. ......... ) ............ ..X~,.~,~,,,.....~.~.\..~......~ .......... being duiV sworn, deposes and says that he is the apphcant above name, ~ (Name of mdt vldual stating contract) He ,s the ........ ~:~~ ................................................................ (Contractor, agent, corporate officer, etc ) of satd owner or owners, and ~s duly authorized to ~rform or have performed the smd work and to make and ~de th~s apphcaBon; that statements contained m th~s apphcat~on are true to the best of h~s knowledge and behef; and that the work wdl be performed ~n the mum set forth m tho apphcaBon filed therew,th  ~ ~R~ PUBLIC, State of N~w Yo~ ..... .......... ........................ (Si~ature of ap~hcant ) I~OIL~ NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE Examined ............. ./. ............. /. ........ , 19~.. ...... Application ,~o ............................... Approved ............./....~'"~..t..~.../. ........ , 19./~....~. Pemit No. '~..~.~...~;...~.. ................. Disapproved a/c ....................................... "x~' ............................................ APPLICATION FOR BUILDING PERMIT Dote ....... ~. ~c~, ,~..~,, .F~., .F.~., ~ ...... ./.~..-.., ~9...~.&. INSTRUCTIONS a Th~s apphcat~on must be completely filled ~n by typewriter or ~n mk and submitted ~n tnphcate to the Budding Inspector, w 3 sets of plans, accurate plot plan to scale Fee according to schedule b. Plot plan showing location of lot and of buddings on premises, relationship to adjoining premises or pubhc streets or areas, - g~vmg a detaded description of layout of property must be drawn on d~agram whmh ~s part of th~s apphcat~on c. The work covered by th~s apphcatton may not be commenced before ~ssuance of Budding Permit. d. Upon approval of th~s apphcat~on, the Budding Inspector wdl ~ssue a Budding Permit to the apphcant. Such permit,shall be kept the premises available for mspectmn throughout the work. e. No budding shall be occupied or used m whole or ~n part for any purpose whatever untd a Certificate of Occupancy shall have b granted by the Buddmg Inspector. APPLICATION IS HEREBY MADE to the Budding Department for the issuance of a Budding Permit pursuant to the Budding Z, Ordinance of the Town of Southotd, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construct~o. buildings, additions or alterations, or for removal or demoht~on, as here~n described The apphcant agrees to comply w~th all apphcable la ordinances, budding code, housing code, and regulations, and to admit authorized inspectors on premises and m buildings for necessary inspectio (S~gnature of ~15phcant, or name, ~f a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or buil( ................................................ ..... .................................................................... Name of owner of premises .... ..d~...~"']~....,f~,,~../..z~.E.~.. ......... ./>..~.~...~...,,~.~.~.. ....................................................................... If applicant is a corporate, signature of duly authorized officer. ~Name and title of corporate officer) Budder's License No .......................................................... Plumber's License No ......................................................... Electnman's License No ..................................................... Other T rade's License No ................................................... ~ I LTl / ~ 1. Location of land on which proposed work will be done. Map No ...................... !-../.. ................. Lot No...Z ................. Street and Number ....... ~.~.~.. ...... ~.,~.%;~..d.(-~.....~....~..~¢~.. ...... ~.~X'~.~.;,~..G..~.~4'A/~q...~...~. ......................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ............... ~./~...~.'7~,/:s/z4g.....4~.. ........... ./f. ..................................................................... b. Intended use and occupancy ........................ ,..~...~...~.. ......... ~.~.~......'.:.~..~....'~....~ .............................. 3. Nature of wOrk'(check which applicable): New Building ....................... Addition ....J,,:~.....~:~..... A~eration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work .... ~'~.~~'~ .......... _ ~/ (Description) 4. Estimated Cost .........~z~...Q.. ..... .~.. ................. Fee ................................................................................................. (to be pa~d on flhng this apphcation) 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 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 .......................................... Depth ................................................ 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 ~ot be regraded .................................. Will excess fill be removed from premises: [ ] Yes [ ] No 14. Name of Owner of premises .~.~;.'-~..t~..A~./x~.~"...,~,t.f...T.~,.~.l.....~:2.6~.~Z2../.ff'/~..~ ........................................ (Address) (Phone No.) Name of Architect .................................................................................................................................................... (Address) (Phone No.) Name of Contractor ....~.~...~.. ...... .~.-~...!....Z~..,'~..~Z'../.,,/b/~,~k~,~..b~...~...~,./..,,~...~'.XT. z4,cP../-~. ....... ..~...~..~..~..~..°Z~.. (Address) (Phone No.) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fro property lines. Give street and block number or descripti.~according [o deed, and show street names and indicate whet er interior or corner lot. STATE OF NEW YOR~K, COUNTY OF ..~'~d'~/~.~.~-..~..~- ........... (Name of mdlvtdual stgnmg contractJ ... being duly sworn, deposes and says that he ~s the apphcant above nam.- (Contractor, agent, corporate officer, etc.) of smd owner or owners, and ~s duly authorized to perform or have performed the smd work and to make and file th~s apphcation; that statements contained in th~s apphcatlon are true to the best of h~s knowledge and belief; and that the work wtll be performed ~n the mac set forth m the apphcat~on hied therewith ...... .da of ..... ................. ............. .. _. · ...............................