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HomeMy WebLinkAbout8135-zTOW~ OF $OUTBOI. D 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) 8135 Z Permission is hereby granted to: · ~d~a~ ~t~te~ , .... l~e~ Suffolk Enelose po~h vlth roof & slereenLU8 ere at premises located at ....~..~...~...~..~..O....~......~..~...~. ..................................................................................... ~ew 8~ffolk NoY, pursuant to application dated . .A...l~.g 8 19 7~ , and approved by the Building Inspector. Ei'C APP~'~,C~Y~:D AS HOTEl:) FEE: /,..~ BY: __~ ' NOTIFY BUll.DING DEPARTMENT ,~'~ 765-180~ 9 AM TO, 4' PM F, OR THE,. FOLLOWING INSPECTIONS: i, FOUNDATIO~q . TWO REQUIREO FOR POURFD CONCREi~E 2. ROUGH - FRAMING 8, PLUMBING'~"" 3. INSULATION ,C FINAL CONSTI~.UCTION MUST BE CQ^4PLETE FOP. C.O. ALL CONSTRUCTION SHALL MEET. THE RE©ftIRE~AENTS OF THE N.Y. ~TATE CONSTRUCTION'& ENERGY [:ODES. NOT RESPON~;IBLE FOR ;~ESIGN OR CONSTRUCTION ERRORS. BUILDING DEPARTMENT TOWNSOUTHOLD, CLERK'S N.OFFICE Y. ~/~/?~'_ ,~~/~._ ~ .q - Examined ...... ..~..¥..~.....~......., 19..~...~.--'~ Application No.....~...~..~..~...?...J ~ ,, roved ............ :..( ............ Disapproved a/c ~-~ ' AF~I.ICATI~ FOI ~UILDIN~ FEI~IT INSTRUCTIONS Date ..................... , 1 ............ 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 areas, and giving a detailed description of layout ofproperty must be drown 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 N~DE 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. ure of applicant, or name, if a corporation) .............. (Address of applicant) (Name and title of corporate officer) Builder's License No ....... ~ ........... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....... ........ .................................................................................................................................................. Name of owner of premises ............. ~..~....~. ................ .~.!.~.. .)..~..Y. ............................................................................ If applicant is a co~orate, signature of duly authorized officer. Plumber's License No ................................................. ~"~ Electrician's License No ............................................. Other Trade's License No ............................................... Location of land on which proposed work will be_done. Map No.: ................. ~..(.,~....~......:....~ ~.t I~lc~f ......... ? .............. Street and Number .... .~.~.....~.....~,,~.~.......~.'..~...~.~.~.~,.....~..~....'7~.. ............. ~~~....;.,,~ ............. / ~ ~" Mumcipality State existing use and occupancy of premises and intended use. and occupancy of proposed construction: o. Exisiting use end occupancy .................... b. Intended use ond occupancy ................................................................................................. 3. Nature of work (check which applicable): New Building,. ................. Addition .....~ ....... Alteration ................ Repair .................. Removal ................. ; Demolition .................... Other Work ..................................................... (Description) 4. Estimated Cost ..~ ................................. Fee ~. / (to be paid on filing this application) 5. If dWelling,'~umb~er 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 ....k..-~ ................. Rear ...\...-~, ...................... Depth .~ ............ Height ....-'C~'.I .............. Number of Stories .... ~ ~..~.....'m~ ................................................................ II Dimensions of same structure with alterations or additions: Front ...... ~...-C. ....................... Rear \ '~ ~ ~ Depth ..~..'..~...~..~. .................... Height ..~..L. ....................... Number of Stories .....I ........................... I-il ~1' I~. ~' 8. Dimensions of entire new construction: Front ..... ../.. ........................... Rear ....... ~ ................. Depth ........................ Height ..]..~...i./. ........ Number of Stories ......... ) ............................................................................................................ " .... !.)...C~Z ................ 9. Size of lot: Front ......t...~.....O..[/. .................................... Rear .......... ..~..~) ......................... Depth 10. Date of Purchase ........................................................ Nome of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... ~...~J ............................................. 13. Will lot be regraded ............. .~ ............. Will excess fill be removed from premises: ( ) .Yes ( ) No 14. Name of Owner of prem,ses ~.C.C~...~..~L.~...~.~...c..~ ......... Address ~..'¢.~,.~.....~...~...~}Phone No ..... ..~ ............ 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 YORI~ ,, ~ S S COUNTY OF ...... .~.O...~...o).I.Q ........ ~ ' .............. ................. being du,y t~ame at inaivi~ual signing contract) above named. sworn, deposes and says that he is the applicant He is the ..................................................... /:I..L~/~.~..~..-- ~ ..................................................................................................... (Con~ ~t'oroc or, 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 ore 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 before me this ....... ...... day of ..... ................. , ' . hJ~ta ~, Puhli~ ~ ~l J~ ('~, ,~,~'~'"~'~'~"~'~''/~ ~///'~; ~ ....... ..................... .............................