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HomeMy WebLinkAbout6661-z FO~M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTNOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISE$ UNTIL FULL COMPLETION OF~THE WORK AUTHORIZED) N? 6661 Z Permission is hereby granted to: ........... ~.~...~l~ ............................................... ~o .....X..~.~_a.~.~... ~.~... ~.~.. ~¢~....~..... ~.t...~ ..~ ....................................................... at premises located at ...,~0~..~. ......... ~t~.[a~l~.~;..~-~"~]Pi ......................................................... .................................. ~.~.~...r..~.~ ..;a~ ........- ~ pursuant to application dated .........................~i~ ....... ~12..i"", 19..~., and approved by the Building Inspector. Fee St ~[,Ofl ............ Bui in 3. Nature of work (check which applicable): New Building .................. Addition .......... :'.j. ..... Alteration .............. Repair .................. Removal .................. . Demoht,an .................... Other Work ...................... .~'_.~' ........................ - (19~s'cription) :~, ) ) '~ ') .... Fee / ';) ' ~`? ~ 4. Estimated Cost .................. ~ ................ ; ............................................................................................................. / (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 additions: Front ....................................Rear ........................... Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ....................... Height .................... Number~?~ S~ories .......................................... .~ · .,.)..,.) .................................. ~..<~.':: ~? .............. 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 1 1. Zone or use district in which premises are situated ...................................................... ;:..;~-,? ..................................... 12. Does proposed construction violate any zoning law, ordinance or regur~ation? ...................................................... )3. Will lot be regraded .........., ......... ;~,'. ..... V~lill excess',f~l be removed fr~;~ pr.,~.se~;~ ) Yes ( ) No 14. Name of Owner of premises .................................................... Address ................................ 'Phone No ....................... Name of Architect .............................................................. Address ................................ Phone, No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly alt building$/-'~h'~th~T'~'i~TitTa--oT~'F~n~'~rd*-'~t ndicate all set-back dimensions frorn property hnes. Give street and yack number or description a~;cordJng to deed and show street names and indicate STATE OF NEW,'¥OI~.K~L COUNTY OF ................................................................................................. being duly sworn, deposes and says that he is the app!icam (Name of individual signing contract') above named. · / He is the ...... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and tha~ the work will be performed in the manner set fodh Jn the application filed therewith. Sworn to before,me this .............. /~..'Z. day of ........ i).....~,....7..j., 19~..: ..... Notary Pub,ic, '~'~L~'~'""~'"'~:'"¢"?"~i~-~.. ""/:.-.z ~ ........ '~;"~"-'~":~: ............................................................ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENTi TOWN GLERK'$ OFFIGE ~ .. SOUTHOLD, N. Y. Examined ...... ~..~..m,~......./...~...., 19..~/~.. Application No. .... ..............,......~ (~ ~/f ....... Approved ...... ~z" ...... '..~. .......... (.~......, 19..i?..~.. Permit No. ~,.~.~.../....~..i .......... Disapproved a/c ..~~~~ ....................................... ......................... (Building Inspector) APPLICATION FOR BUILDING~pERMIT ~ate .............. .....~ ................. , 19. INSTRUCTIONS a. This application must be completely filled in by typewriter or. in idk and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according t~ schedule. b. Plot plan showing location of Jo~ and of buildings on premises, relationship to adjoining premises or public streets o~ areas, and giving a detailed description of layout ofproperty must be drawn oh the diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of Bu Id ng Permit. d. Upon approval of this application, the Building Inspector will issue a~ Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the workI 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 i~suance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New ~ork, and other app cable Lows, Ordinances or Regulations, for the construction of buildings, additions or alterations, or f6. r removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, buildidg code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. - ~..~:...~..:?v.~. h.... ~,/!. ,~. ..... ~. ~.~ ~.~i,...,:'~:?..:~....; .................... (Signature of applicant, or name, if o corporation) .......................................................... (A~dress of applicant) State whether applicant is owner, lessee, agent, architect, engineer, genera( contractor, electrician, plumber or builder. Name of owner of prem ses ~;: ~ z ./. ~ ' ;?;f:":t~ ,~ d.,, ..................................................................................... If a~pli¢ont is a cerparote, signotare af duly outharized afficer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. No. Other Trade's .............................................. ~//k~' ~' /%7- q.%License andonwhch ro os ' ' ~'Ma Location af ' p p ea work Wm ~e aone,, p ~No.: f.y.~;~: ...................... ,.....>, Lot No ........ Street and kh,~h~ /, Municipality State ex~stmg use and occupancy of premises and intended use and ~cGuponcy of proposed construction a, Exlsltmg use and occupancy ...................... b. Intended use and occupancy ......... : .............................................. j .................~'.2~:~....~...~..}~.~mM ......