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HomeMy WebLinkAbout8799-z FORM NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE V~ORK AUTHORIZED) N? 8799 Z Permission is hereby gmn~ed to: - · ,o, .......................................................... al premises l~o~ated at .... ~....~~,~{ ................................................. fi ~ .... ;,.:..~ ........ ~ ................... ; .............. ~ .................................... ,;Emil to'~gpplifatibn dat~ .... ~ ~ , 19~ and a roved b the ;" Building In~p~tor. . ' ' ' Building In~ector 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 UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°. 8609 Z Date Permission ,s hereby granted to: F& Mat1 Build an addition on exist fo at premises located at 2020 Marl .tuck pursuant to application Building Inspector. Fee ©. .......... N 19..?.0..., and approved by the Building nspector FO~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWH CLERK'S OFFICE SOUTHOLD, N. Y. Examined ......................................... 19 ........ Approved ........................................ , 19 ........ Permit No ..................................... Dtsapproved a/c ............................................................................................ Application No ................................. (Building Inspector) APPLICATION FOR BUILDING PERMIT Oate ......................... .......... ,9.Z? .... 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 adloimng premtses or public streets or areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application. c. The work covered by thts application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector wHI tssue a Budding 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 tn 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 Budding 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 or for removal or demolition, as harem described. The appliccnt agrees to comply with all apphcable laws, building code, housing code, and regulations, and to admit authorized inspectors on premises and in, buildin ~ry inspections. F&H Fred Helf of applicant, or name, if a corporation) Ave u~attituck (Address of applicant) State whether applicant is Name of owner of premises If apphcant is a corporate, si lessee, ngineer, general contractor, electrician, plumber or builder. C. :i of duly authorized officer. (Name and title of officer) Builder's License No...?. ....... ~ ..................................... Plumber's L~cense No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Map No .. · ~ .......................... Lot No. ~ .............. Street and Number .... ~..~[t.'lj.~e...J~.tq~ ..............]v~.i.~Ua~; ................................................................. Municipality 2. Stale existing use and occupancy of premises and in.~ended use and occupancy of proposed construction: a Exisiting use and occupancy dweq~J.~§ b. Intended use and occupancy same with addition Disapproved o/c ..................................................... IrOB~ NO, 1 'tOWN OP BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter o¢ in ink and submitted in triplicate to the Building Inspector, with 3 set~ of pla~s, 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 pubiic streets at areas, and giving a detailed description of layout ofproperty 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 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 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, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature f ap licant, or name, i a corporation) ................. ............................ (Address of applicant) State whether applicant is owner, lessee,~.~/amhitect, engineer, general contractor, electrician, plumber or builder. ............................................ ' £ .................................................................................................................... Name of owner of premises ..~C.,...~6.~...C.C~.......~...~Q.~.O~<Z~' ............................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ....... .~..~.~....~...~....~.. .................... Plumber's License No ................................................. I ~ Electrician's License No..~........~...~.C~.~... ....... ~ ~ Other Trade's License No. ~.~,~.~..T...~..~.C-~.....~..~.IQ.(~ ~ L at'on of land on h' h d k I1' d e Ma No ~ L t' '~ oc i w lC propose wor wi De on . p -: ......................... /..%~ ...... 0 ~40 ......................... .~, Street and Number ~L~D.~...../~L~C..[C.~...~c..~....~:~.?~?~:..~LL~?...~..,.~..:.....'' ' . .......................................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy .. ;, [.f~ .... C~. ..................................................................................... b. Intended use and occupancy ....~...L.~,.....~.~.i.~i~.~.Cr~.....,.~..~...~ ............................................... 3 Nature of work (check which applicable): New Bui!ding'. ................. Addition .................. ~ Alteration .............. Repair .................. Removal .................. Demolitior .................... Other Work .................................................. (Description) 4. Estimated Cost .... .i."~,~....a~... ........................................ Fee ..../...~........... .......................... (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 ca~ ............................................................................................................................................ 6. If business, commercial or mixed ~cupancy, specifx nature and extent of each ~pe of use ............................ ~ / ,, .~.~.:.~..:.(. 7. Dimensions of existing structures, if any: Front ...... .~.~. ............... Rear .~.~...~..: ............... D~pth Height ........................ Number of Stories ....... ] ......................................................................................................... f // 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 ......... ~D..D ...................................... Rear ..... Z.Q ............................... Depth ..... ~ .................. 10. Date of Purchase ........................................................ Name of Former ~ner ........................................................ 11. Zone or use district in which premises are situated ~.~ ~ ~ ~.~ ~]. ............................... ]2 Does proposed construction violate any zoning law, ordinance or regulation: ...... ~.O. .......................................... 13. Will lot be regraded . ......~.D. ............. Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of ~ner of premises ~..~Z~.~.~..~.t~.~C~.~. Address l.~t~..~ ........ Ph~e No.~2..~.~.~ Nome of Architect .............................................................. Address ................................ Phone No ....................... N~me of Contractor ~.~...~.~ ................................... ~y ,~u ~ Address .M~..~ ...... Phone No. PLOT DIAG~M Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-~ck dimensions from propady lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. ..... ......................................... (Name ~/~al signing contracf) H, ~, th~ ............. ~...~~:: ............................................................................................................................... (Contractor, agent, corporate officer, etc.) of s~id owner or owners, and is duty 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 belie~; end that the work will be performed in the manner set fo~h in the application filed therewith. Sworn t;before me this ........ ~.~ .......... ao~ o, ...~.~r .................... ~oto~ ~b,~,. ....... ~.~.~{ ................... c~ ...................................