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HomeMy WebLinkAbout6373-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) UNTIL FULL N? 6373 Z Date ........................ .?.~.~.. ....... ?..~ ............ , Permission is hereby granted to: ~d,~..~',o~,~,..~t~e...C~..~J.~.....PauL.',P. ed~r-sen .......... .~.1~ .¢;L.~:~.I~ ................................. , .............. to .~ir~cL..and...e r~c~., f~e ...................................................................................................... at premises located at ....... .L~t..~.....~e..~,~a~ ....... t ..................................................... .............................................. ;~m:~ez.. L~e .............. Da~o~ ...................................................... pursuant to application dated .........................~ ....... ~ ........... ~., 19.~.., and approved by the Building Inspector. Fee SJ.ff...0.O ............. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, FI. Y. Approved ~ ~ ........................................ , 19 ........ Pemit No ....... : ....... ............................ L~ ( B ~'ddin~'fnspector) I .... , LO APPLICATION FOR BUILDING PERMIT Dale ................ .................... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, witl~ 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, relationshi~ to ad oining premises or public streets or areas, giving a detailed description of layout of property must be drawn on diagram whi(~h is part of this application. c. The work covered by this application mey not be commenced before issuance Qf Building Permit. d. Upon approval of this application, the Building Inspector will Issue a Building Permit to the applicant. Such permit shall be kept o~ the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancv shall have b, granted by the Building Inspector. . APPLICATION IS HEREBY MADE to the Building Department for the issuanc~ of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, SuffolN County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The apphcant agrees to comply with all applicable laws, ordinances, building code, housMg code, and regulations, and to admit authorized i~spect6rs on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation} (Address of applicantl State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........................................................................................................................................ Name of owner of premises .... &rx../,,...~ .~Z.X.~A/ ....................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ...................... ~. .......................... . ............... Street and Number .....~-*~:~ ........... L,.....~ ................ .~ '.~:&..~. ...................... :t.~.... ............... Muni~:ipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..,..6..~..A..(L.....~:~.r~.L.(...7, ...... ~. ,/~..~...L...L..:i.0./.~.'...; ............................................................ b. Intended use and occupancy t t ~ ~ : Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work ....~..~...(,.~-~ .............. (Description) 4. Estimated Cost .... 0.~.~. d. 2). ................... Fee ................... ..~..~'..~..0 ................................................................. (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 of Stories ......................................................................................... 9. Size of lot: Front ............ /.t/.O. ................... Rear ............ ,LIZ~ ...................... Depth .................................................. Height .................................................... Number of Stories ...................................................................................... 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 lot be regraded ..................................... Will excess fill be removed from premises: [ ] Yes [ ] No 14. Name of Owner of premises ..z.cz..q. .........:..~..~...~..::.../,Z~x. .......................................................................................... (Address) (Phone No.) Name of Architect ..................................................................................................................................................... (Address) (Phone No.) Name of Contractor ...~....¢E/./. (.~..2.../T.~.~..~.....~Zd...~-;c.../~. .......... ,,,~ ~ .~.~/..[..~..(;ff. ......................... .~..~..c~.~...~..~.7..2 ..... tAddress) (Phone 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 er interior or corner lot. /,, /.. deed, and show street names, and ir.l,dicate wheth- STATE OF NEW YORK ~ COUNTY OF .............. ,,~ {d..~..~.,,~.. ,L2., .~... ........... bb .~~~.~)~~~~ ~~' --- .................... being duly sworn, deposes and says that he is the applicant above named. (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 knowledqe and belief; and that the work will be performed in the manne~ set forth in the application filed therewith. , , c t flew York , -- / ................. ~..F........;.,..day of ...... "";<~'~~,m~ ~,~,',,,;¢h 30, l'~/' // ~// .~/ · , ..... zz , .............