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HomeMy WebLinkAbout8134-zFORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT. TOWN CLERK'S OFFICE r SOUTH'OLD, W Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N° 8134 Z Date .................... Aug ............ 8.............. 19.75.. Permission is hereby granted to: $ CPrg..Fy53}1%^f3Y$................................................... ..................... ma.tt It ..................................... .............. I.......................... toE-•-0¢t...f-a oing... �...p�a�••ar i� 3aa•��ean at premises located at .-)j1fd••i+JE>0da- j-f-f..4)3?j-ye............................................................................. ...............................................................wt Liasie........wa;....................................................... ................................................................................................................................................................. pursuant to application dated ........................ Aug .... e.................. 190.5..., and approved by the Building Inspector. Fee $15.6.00 .........6�ing........BuildInspector • Ci�_� _,. W^IC YOYCLI CHKO. BY_„ ------ DATE-------- _____________________ DEPT. on PROJECT, d . N 8° 3Vol ©� iferce- -7, Ira -7,sra. N 0 00 Al . 0 c- t -q Gam.. MAP o f PA AT 0 0we-sr viVw” A d3 r t4 L We SfVIL w h!?IV� SHEET No -------- G JOB No, go Rif# I Disapproved a/y.... . ♦ . .1 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 19.7.5. Application No. ..:...../...... / 192. Permit No. ---J4--..-/ .. ............ �"� ............ .................1..... .......................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date a. This application must be completely filled in by typewriter oe 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 at areas, and giving a 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 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. :.'.. ....... .. ....... ......................................... (Sign ure of op cont, or name, if a corporation) �............... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. 0 U//V A ,.�/'�.................................... ...................................................................................... I.......... Name of owner of premises ..........1 1...?. ..�Z.�...... . OF. If applicant is a corporate, signature of duly authorized officer. .................................................................... (Name and title of corporate officer) Builders License No. ...... ".......................................... Plumber's License No . ................................................ Electrician's License No . ............................................ Other Trade's License No ............................................... 1. Location of land on which proposed war will a don p No.: .... o.:.... ........... Lot No......................... Street and Number CrIJ4 c !...............�Cg:G 1' .................................................... ����� � Municipality 2. State existing use and occupancy of premiss and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ............ ................................................................................. JI --- b. Intended use and occupancy................................................................................................................... 't U` � work ^ " ^ / � of � ( h kw�i h applicable): New Building /\66idnn ......... Alteration —~..`. . .� 3� Nature (check c � Qenonvo| Deroo|idoc ..—....— Oiher\x/n,k .�,/�.����.—..~^,,^,_,, ,. Repair —..~~—^~ ~^—^^^^^ ^ (Description) ^^'^—� F�� �L��... - ..—..~—.'~~,.,,,,_~_,,^, ,,,,^,._ 4� Estimated Cost ................................ (to be paid on this application) Nun�6oruf6*o||ingunitsoneoch f|oor.~,..—~'.,,,^ 5. If dwelling, nun`borofJ°/e||ing units ......'~.~.~. ^~---~~^"^^^~^-�~~~—^^`~^~^^'^^^ |fgarage, nwn`be,ofcors --.~'....~.^.—.--~^^^^^^^^~—^* 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ �nor � Depth °..—.....� 7. Din�cnsionoofexisting structures, ifany: Front ---.---'..^ ..~..,..~—.~—� -. Height ........................ Number of Stories ..~^~~.~^^~^.~^^~~^^—^—.^^~.~^.^.~—~..^........'.'' Dimensions ofsome structure with alterations oradditions: Front .................................... Rear ..... ..................... � Number —.^—_.—~� Depth ..—^...~...... Height ~'.'.—..^~.~' ^~^'^ -` Rear .—.�Dwpth..........^� 8. Dinoonsinnsofentire new construction: Front ...—~.',,'.~^~.. ..—.^^^.. HoiO6\ .................... Number of Stories ,..~~~--^``.^'~^^^--^~^'^'^^^^--^—^~—..^.—..^..^—^.- Kcur...........~.....'........Dop|h....,.—.~~..... 4� Size of |cd� Front ...~...~,...--^.'^~--'^~� lo. Date of Purchase Nun�eofFn,n�orOwner —...~—.~~~.~—.^.—^..,,,,. ..~.—'~',...'-.—.—..—..~. ll. Zone oruse district inwhich premises are situated ........ 12. Does proposed � construction violate any zoning |n., ordinance or regulation: ........................................................ 13. Will lot be regraded ^....'.`..... Willoxceos fill be removed from pm ren`as�� ( )`/ao ( )Nn /\66n�ss ^^...^...°.°°^°.^ Phone ,°°~...~~. 14 Mon��uf(}vvnorufpren)ioos..—.--~...—......'^^.— ~ � /\dJrpss..~..~..~°...°. Phone Nb� ^^~°.~~... Non000f/\/chitoct......—^.~—^.—^.—....~—..~^. NocoonfContractor Ax]6,oss.....~......~... Phone ��o� ~.....^~~~ ,...^—~^.—~^~'—^.,.~'....� PLOT DIAGRAM Locate c|pvn}yand distinctly all buildings, whether existing ~'7'rd,nnJin6icu|eo||vet`bock6inonsionsfron property lines. Give strnetand block number deschy�i000~-o-"{ndead,nn6shvwstreetnonw*on6indicote whether interior orcorner lot. , 6 /\ «f V/ / (7- � » STATE OF NE�W �ORI| Cu"/'...^,~.^being duly sworn, deposes and says that he is the upp|iruns ---����a of in6ividLKa| signing contract) above named. ^^�~—^^^`^'^—'—~—~~^~—^^—^'^'^—`^^'—^'~'^—^^`~—^~ Heivthe '^~�>"~c������^'`~��^^~—^'^—'^-- � &�officure�c) — (Cnntno��u�ngant�n,poru ' � ofsaid owner »rowners, on6isduly authorized to ��rfonnorhave performed the said work and homake and fi|- thisopP|icotion; that all statements c«ntoi»«6in�»/suoolico{ionorotnuotothm6estn fhis knowledge and belief; on - that the work willboperformed inthe manner set forth inthe opp|icutivn filed therewith. Sworn to before muthis 6.., .. County.. Notary Public, ` Notary Public, State oxNew York No. »2.4399485, Suffolk I ,I I li li I I I I T W00 DHOMES MONa AUK HWY., HAMPTON BARS, N.Y. 19,46 REVISED JOBPURCHASER I .. N0. C LOCATION s�• I i I ,I I li li I I I I T W00 DHOMES MONa AUK HWY., HAMPTON BARS, N.Y. 19,46 REVISED JOBPURCHASER I .. N0. C LOCATION s�• t. ` rY 1 F—•T9—x—j�i � . m iy- A — 1 -_----- _ AS -0 wo M00AUK "Y., A!1!TONL Joyt •r nen:-. k � 6 F � �iffi b tt �I Im- I I _ a WY_ JI II �4 �3 w1. ,�+ t 4 I 1: si t. ` rY 1 F—•T9—x—j�i � . m iy- A — 1 -_----- _ AS -0 wo M00AUK "Y., A!1!TONL Joyt •r nen:-. k � 6 F � �iffi b iQ Im- I I _ a WY_ JI II �4 t. ` rY 1 F—•T9—x—j�i � . m iy- A — 1 -_----- _ AS -0 wo M00AUK "Y., A!1!TONL Joyt •r nen:-. k � 6 F � �iffi b iQ Im- _ a WY_ JI �4 �3 w1. ,�+ t. ` rY 1 F—•T9—x—j�i � . m iy- A — 1 -_----- _ AS -0 wo M00AUK "Y., A!1!TONL Joyt •r nen:-. k � 6 F � �iffi iQ Im- `.4 w1. ,�+ t 4 I 1: "W�Ii l l4'b dYIYySL Yk. f'J '° y AY�.?'NiN �'S4VC4a b'YiF�f+Y'!'14"'�i'114i!'-,.YirM �M 31:1T r 5JY Y, i �1. _ 1 Kvti:d' tfi4 4'-'+i�Y.' .u3 ' ..'.c . 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