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HomeMy WebLinkAbout7114-zFORM NO.2 TOWN OF SOUTHOLD' BUILDING DEPARTPAEt T TOWN CLERK'S OFFICt SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMI ! SES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N97114 Z Date ......... ............... ,, G.r .......... J.1 .......... 19-7)+ Permission is hereby granted to: Twiil rork .......................... ........... . ..... ................................ ................................................................................ e -ha -in ... llnk- -f erxewre-*,r ... y&rd .. area-*—Perst .. &--ratl in ... hal. ............... 9-th ............................................................ at premises located at.L.P-31,i2 .. liOad ........... .............................................. ....... . ............................................................ ............................................... N -Y ........... pursuant to application dated ...... Building Inspector. Fee $..:.......... ..r.....:....9.1... 19-71+.., and approved by the Building Inspector FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE! SOUTHOLD, N. Y. ��Examined .................. .....�......, 79........ %% Application No. Approved�J....l yy ................. L ..............�......., 19........ Permit No......... C...�.......'":...... Disapproveda/c ............�................ .....................................:.. ................................... ...................'................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT 1 Date....................! %.................... 19............ INSTRUCTIONS a. This application must be completely filled in by typewriter of,, in ink and submitted in triplicate to the Building Inspector, with 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 public streets oa areas, and giving o detailed description of layout of property must be drawn on the diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue to Building Permit to the applicant. Such permit shall be kept on 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 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 Fork, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal -or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, buildi'n code, housing code, a djregulotions, and to admit authorized inspectors on premises and in buildings for necessary in ecIons. lye -Z (Signatur of �applic in j, o name, if a corpora tion/) ... ••.• •..•.•. •....• • .... • .•..i... ..... ............. ••.. .... (A ress of applicant) State ether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. t.v................................ !i ................................................................................................................... ^j ................. Name of owner of premises ....f .,/ i_t 2A2 , 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 Trade's License No ............................................... 1. Location of land on which proposed or(k'y,will ne. 4c :....AGV- cT1`.!...>.......... Lot f b 1 Yf�2 j. ,..t.. ... f...cam.. Streetand Number...................:...........................................��.......:...................................................,.,.......... M icipality 2. State existing use and occupancy of premises and iWende use and; occupancy of proposed construction: M a. Exisiting use and occupancy ...fJfr S .. ............................................................. b. Intended use and occupancy ............................. .................................................... ........................................ p ............ ................. Demolition.................... Other Work .........� n .................. 3 Repair of work (check which applicable): New Building ............... Addition Altet;pt Removal ption) 4. Estimated Cost ..........................70. :... 7...........Fee ...................J'S ... U lJ ................................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................Number of dwelling units on each floor ........................... Ifgarage, 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 some structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................Number of Stories ................................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height.................... Number of Ftories....................................................... ,.................. ....... ....... .......... ..... .............. 9. Size of lot: Front ..........%• ....................................... Rear ............ ..................... Depth ....3.................. 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 ..........,J/....................Will e�jcess fill be removed from Arises- ) Yes ( ) No _ 14. Name of Owner of premisesL%61..G1.� an Wt ....✓ t.;e/.044...... AddressC�.. G`..;.... Phone No. 7scL.:..5........ 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. STATE OF NEW COUNTY OF .... ......................................................................................... (Name of individual signing contract) above named. H . th r XA ...being duly sworn, deposes es and says that he is the applicant eis e................................................................................................................................................................................. (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 thor the work ill be performed in the manner set forth in th application filed therewith. Sworn top7ft me this G , ................... a 19 Notary Public✓% gL ........... .. County ......y ....•...•..... .,...lf:'....... y- JUDIM T. BOKFN (Signature of opplicaniJ Notary PUNIC, State of Now York .1/ No. 52-0344963 S0,11< County Commission Expires March 30, 19e Examined;�P_�jj Approved.................`:f..........1..(..... 19.2Y 192 FORM NO. 1 but !-' d TOWN OF SOU THOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE _ SOUTHOLD, N. Y. Permit No. -.I. ..`..... Application No. ........... Disapproved a/c ......... ............. ................................................................................................................. .......................... ............................. (Building Inspector) -APPLICATION FOR BUILDING PERMIT` Date............. ..................... 19.. ....... INSTRUCTIONS a. This application must be completely filled in by typewriter or! in ink and submitted in triplicate to the Building Inspector, with 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 public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this application. r c. The work covered by this application may not be commenced before issuance of Building 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 work. 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 issuance of a Building Permit pursuant to the Z 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 for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, buildi g code, housing de, and regulations, and to admit authorized inspectors on premises; and in buildings for neves 9 y i spec ions. % �..... .... .:�.. ............................... (Signature of appl' ant, or name, if a corporation) .- Via... �... ...�1.:..j.:... ( dress of a licantp PP State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................................. . . .. . .... .... Nameof owner of premises .. .................................................................................................. If applicant is a corporate, signature of duly authorized officer. ................................................................................... A (Name and title of corporate officer) Builder's License No . .................................................... Plumber's License No . ................................................ Electrician's License No...........1i................................. Other Trade's License No............................................:.:s 1. Location of land on which propose worc will done. p No.:....,.... vAa,?-.Gam}...�..... Lot o [........... Street and Number,....1.........r./.............................. �....... M icipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a.Exisiting use and occupancy ...�...wh�;y% ............. ..... ral b. Intended use and occupancy.................................................................................................... f - 3. Nature of work (check which applicable): New Building-".:' :............... Addition ...: Alteration Repair .................. Removal .................. Demolition.............. Other Work ........G. ?...... .. .. (.De iption) 4. Estimated Cost ......................... f. aor.......,%...........Fee ... ................. 1.��.,... A..................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................Number of dwelling units on each floor ............................ Ifgarage, number of cars ..................................... .......................................................................................................... 6. If business, commercial or mixedoccupancy, 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 'odditions: Front .................................... Rear ............................ Depth ................................ Height ............................Number of Stories ................................ 8. Dimensions of entire new construction: Front .....................................Rear ............................ Depth ........................ Height.................... Number of Stories .......................................................4............................................. 9. Size of lot: Front..........l.5.5...................................... Rear.........../H....................... Depth ...3.,3.1.................. 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 e cess fill be removed from pr mises. ( ) Yes ( ) No _ �/)aa 14. Name of Owner of premises x". .. „� �.... Address ���........ ( .:.... Phone No. 73.`%'7S 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. AA - I STATE OF NEW 1 COUNTY OF .. . . . ............f S.S ..................................:.....................................................:.......being duly, sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. Heis 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 than the work will be performed in the manner set forth in the application filed therewith. Sworn to be me this ........... f`. � day of {. 197 � Notary Publi '. c.al� .../. .... County ........................................ JUDITH T. BOKEN ( ignature of applicant)— Notary Public, State of New York No. 52-0344963 Suffolk County /11 Commission Expires March 30, 19 If , " . , : ': , I I ". - 1,ii " - "I ; ',�,'�', !t;, ��-,�,, ,�"!� : , � , " I - I . , , , �.. , , . - , ", �11 ,,,,f 41II'.� � ., '!,'I- I I i, . Ili � �r , I ,,, , ,\ _ . , ,-O�V��j . ,� � � � Ij '�� . , ,"I. , . , , �,�,,. � , _.�,�Jlt,i, . 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