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HomeMy WebLinkAbout6670-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 COMPLETION OF THE WORK AUTHORIZED) N°. 6670 Z Date ............. UNTIL FULL Permission is hereby granted to: ~.ame ~...~k. ~$ ~am..... ~ull~Lv~n ...i ................. ............. 8au~J~o3.d .............................. i ................. ct premises located at .....~D.~.~.....~D.~..~......]~ell,~d,~']..,l~.~, ...................................................... ........................................... i],Og, e~'~..& ..~&r]pad-~ome.-.9.1,....-.:.--.-4~m~41 ................................. pursuant to application dated '. ..................... ~r~.....~O ........ i'"'" 19~..., and approved by the Building Inspector. Fee $.~.,.P.O. ........... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMEN'I~ TOWN CLERK'S OFFICEi SOUTHOLD, N. Y. Exem ned ....... ....... Approved ....... APPLICATION FOR BUILDING PERMIT Application No ................................ Dote ........... ~e · ']L~3 ....................... , 19...?.~ ..... INSTRUCTIONS o. This application must be completely filled in by typev~$iter o~. in ihk and submitted in triplicate to the Building Inspector, with 3 sets of plqns, accurate plot plan to scale. Fee according t~o schedule. b. Plot plan showing location of lot and of buildings on premises, relohqnsh~p to adjoining premises or public streets or areas, and giving o detailed description of layout ofproperty must be drown ~n the diagram which is port of this application. c. The work covered by this application may not be commenced befor~ issuance of Building Permit. d. Upon approval of this application, the Building Inspector wilt issue 9 Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the wor~. e. No building shall be occupied or used in whole or in po rt for any purpose whatever until o Certlficote of Occupancy shall hove been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the iissuance of o Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New ,~ork, and other applicable Laws, Ordinances or TR ~geU la~,~ ~ ~'n ft °ar gtrhe~ sC ?~ Sct roCmC tpiiTw~tfhb~il dai ~gp~i'c ~bd ,deit [ a°wn~;'c~ r~ Ii ~' ~ tcie~ s~ u~l~ ,~ rc~d%?~lo uC. ~.j~C' 'e c%~ie~ i~n~ da ~ehg~it ino ndse, S ~r~ (~etd~ admit authorized inspectors on premises and ih buildings for necessary in!pections. / ] ~// ~ State whether applicant is owner, lessee, agent, architect, engineer, gener0[ contractor, electrician, plumber or builder. Name of owner of premises ............ ~/'~"&i"'~*J~' ..~bL'ae.~i..~.~t.~'~ ....................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ............... ,~ ................................ Plumber's License No ................. ~/.~ ......................... Electrician's License No ................. .~/.~ ..................... Other Zrade's License No ..................... .n/.tt ................... Location of land on which proposed work will be done. Map No.: ...... '::Lb?'2 .................. Lot No .......... ~ ............. Street and Number ................ ,t~f~,mtr~.I),'z~'c~r.~]..~,..~;~ b~e~ .................................... ;-....~.be'l.d ..... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy .................................. ~t/t~ ...................................................................................... b. Intended use and occupancy .................................. -I~/~ ...................................................................................... 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work ....... ~.~ .q g.~.a..d..e....~.e.~.g~.......~... ~,. :. (Description) 4. Estimated Cost .........~.3.9..©. ........................................... Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ........ ..~.if~ ............. 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 ........~.i.~ ............... 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 ................. ~1/~.~, ............. Rear ............................ Depth ........................ Height .................... Number of Stories ..................................................................................................................... 9. Size of lot: Front .............. 10..~..~ .................................. Rear ............ 10.(~.! ...................... Depth ..... ~..6..~. ..................... 10. Date of Purchase .............:L9.53~ ................................ Name of Former Owner ..... ~.9.~.Af~kn~, ........................... 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ............. ~9. ....................................... 13. Will lot be regroded, . ......... i'~/& ........... Will excess fill be removed fro.m, premises: ( ) Yes ( ) No · Hz ~.ro~e Dr. 14. Name of Owner of prem se~l~.¢~.~..~ft~.:,9.~..~.~.~%Y.!.~ ......... Address .. ~.e]~e.c~gA.,~.~.~.,.. .. Phone No. Name of Architect ................. .~.~.~ ....................................... Address ................................ Phone No ....................... Name of Contractor ..................... .~./.~, ................................. Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ex~ting 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. Lot I -7 STATE OF NEWer'aRK, -- .~A icc cou,T¥ ..... ..~C~.~....~.~....~~'~t~ ............. being duly sworm, deposes end says that ho is the ~ppllc,m (/ (Name of(i~l s~ning contract) ' able name.d.~ 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 forth in the application filed therewith. Sworn to~fore me this ,, Notary Public, ................. PAY NORTH FO~<BAhK ,~ TRUSt ~. // /~gno~re of applicant) [b~ ~N9c~ELER N~ary Public, State ~w M~r~r~ll~ No 5? 30410Q0