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HomeMy WebLinkAbout8137-z FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) U Z Dot .�+!%S./........... ... 19. ..w✓ N 8i3'� � ��' Permission is hereby granted to- ./ . Al to ..��. ..... `e.'a c ..... .. �, �' ......11.V"'..��' �"� .. .;.!gram?. .......................... ..... .................. ........................................................................ atpremises located .....:7©......... ................................................. .................. . ....................... ................ ... .... ............, .: . ...................... r .. r .................. ......�z ,....,r ?�- ........ .................................... pursuant to applicatio dated ......../ C/. ? !�......4`... ........ 1 ' . and approved by the Building Inspector. Fee .. .......... L Buildi g�lnspector _ "k f A C4T Pew- PA&*, FORM NO. Y - 107 �,�,�� Y 4cc 1 n TOWN OF SOUTHOLD 11,em cA� )Zz, BUILDING DEPARTMENT TOWN CLERK'S JOFFICE �' '`� " ✓� �1 SOUTHOLD, N. Y. '� Examined ...... ..'.4p.. .. 19 , Application No. d2l ........... Approved ................................�,......., 19.// . Permit No. � �.....�.... Disapproveda/c ............................................... ........................................... ) ............................................................... ... ................: ...................... tel: A , . . �� . �f ing Inspector) APPLICATION FOR. BUILDING PERMIT p Date ....... ��.... .... .. 19_20 . .., J INSTRUCTIONS 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 or 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. ............:.... ..... ignatur of applicant', or name, if a corporation) 7. Address of app�'icant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .............T.....�4U ............................ ....................................: .................................................................................... Name of owner of premises .... ..........A ........... .C. :J.. ................................................... If applicant is a corporate, signature of duly authorized officer. ........................................................................................ (Name and title of corporate officer). Builder's License No. .................................................... ril Plumber's License No. ................................................. Electrician's License No. ............................................ Other Trade's License No. �\ !Mt A 1. Location of land on which proposed work will be one. Map NaeJ.Ci,�,�j .i�IZ. . .. yot No. �G..—........ Street and Number .... 0lJ....�,.G7trl?/1. .. �� "F.......................................... " Municipa ity 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ....... „61. .... 1�'J.r°/�t� .. .................................. . b. Intended use and occupancy ......�.,�d,�' �.. ....,eQ/� :,Gr�......e�Aj ........................................ 4CC' 3 Nature of work (check opp|icob|a}� New Bui|6ing� —.-��—.—. �u@�itio� —.-----. ��it�roton .---..^. . � . - .'' � Repair .................. | Oon`nhion�..'_—,--- Other \A/o�k —.--------------- ,— ' (Description) � ^� � " � e.4 Est notod Cost ...........................- ' -'��7n.--- — *:Tm:�=� .............................. (to be paid on filing this application) m ' 5. If dwelling, numberof,dwelling Number of dwelling units on each floor -_.'--_-_--- . ^/ ' - Ifgarage,'number of cars .............�.-- ----.--.-, ...................' , ^^ ` 6. If business, ccmnmenc/o� | or ,rnhxod occupancy, spoc/`fv -nature onH'extmnt of each type of.use ............................. 7. Dimensions of exist ng structures, it any: Front ............................ Rear ................................. Depth ..... Height -':r=.-. ---�� 4 r ' Stories __—'_--.—.r--_---'.__---'_.------_--'------------- Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth .-----_.—__—' Height .....................Nun�6er of 3tohas .................................... . --- . �~ / , '+ 8 Dinnmns no� construct�m``Front �'~u�r ' . Rear � �eof� �� ' '~= �^~ '^^~ �� ' ---'r---'------' '- --,-''------^- Depth.—�''�~------' Haigh+ -��-�~~0' wunnber.1of Stories '---�����—'-------�''�-�—'-----------.--':---r---- 9- Size of 1ot: Front ............ ----------' Rear .......................................... Depth —.---_-----~.. . lO. Date of Purchase ........................................................Name of Former Owner —_'--_.----_'.'�.-----............. ` 11. Zone or use district in which premises ituota6 ---.---_--__—.--_--.-_.--_---_--.-�—__,--. 12. :Does proposed construction vin|ote,i6y zoning |o*v ordinance or regulation: ........................................................ 13. Will lot be regraded. ..... ........... Will excess fill be rem8vecl from premises: Ye No l4. NonnoofOwnerofprenn . Address/ ......--.-. . Nonne'nf Architect -------_r----'._--.--.— Address No. ...---.-.-_' . � Y4onne' of Contractor --------------.------' Address .................. Phone............... � ��o ...................... _ PLOT DIAGRAM clearlyLocate all buildinjs, whether existing or proposed, and indicate all set-back dimensions from .property. lines. Give street -and block number or description according to dead, and show street nonnas and indicate whether interior orcorner |o� EJ ~ / ` ' ` '- . . ` -` _ . . . . \ ' ` ' ` — ' �� 4.� » � �~ � � �� ' =° _, U. � ��^�� �-�����' . � � \ . STATE OF NEW YORK I ' CUU[� [Y OF ^ -�--- ` -- . ' -----'boing duly sworn' deposes and says that he is the opp|iconi ' (PaQ or /norvmuo/ agn/ng contract) ' above named. He is the ------'--------T' -- (Con'tractor, agent,, corporate 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 |[ statements contbin'ed in, this opp|ico+inn ore true to the best of his knowledge and belief; and fh thework will be performed i theset forth i theapplication filed therewith. Sworn to before me this '`~`~/ Public ---------'-^°-^ ' - ~~~'-x - - ------__----______________~__________ � (Signature of applicant) ~�~ ~ tIEVI '- ouZ^13""' _N nv`°~' '~-- oo��^ '1 �c-1 U - 13 t I~OEM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S oFFICE SOUTHOLD, N. Y. Examined ....... ~ff~.~ ....'..~. ..... 19/'~.<.~.- / Approved /~ '" 19.../../.., Permit No. ~.../..~ ./.,.,...~ ..... Disapproved a/c ....., -'-'~ ............. ~:;; ......... ii~ .......... i ....... L' ........... i"i ....... Application No..~..~./.'~..-.~...7. ......... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by b/pewriter o~. 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 oJ 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 shell 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 wit[~ all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. ~i.........;~!!i applica'nt' °2m, e.~. a~)~ ........ ................... 0'Address of ap~icant) //K~/ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............ ............................................................................................................................................................. Name of owner of premises 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 work will beftone. Maj:) N '~..~,,~¢~.~ef~.-.,/~..~.~.~/.~_o~ No. ~...'~..':...~...~..../..~.~.¢'~ Street and Number ../~i~zill....~../~..(~'.:i/.//.~...~<'.~ / ~ Municipality 2. State existing use and occupancy of premises and in~.ended use and occupancy of proposed construction: a. Exisiting use and occupancy ....... .(~,J~.~....2TT....x~..~.!..~...~.~.. ...... .~....~.~.../../~..~.~.../.. ....... c . b. intended use and occupancy .............. ~ ......................................................... 3. Nature of work (check which applicable): New Building' ,..../.. ....... ACtion .................. Alteration Repair .................. Removal .~, ............... Demolition .................... Other Work ................................................... (Description) 4. Estimated Cost ..................... ~.~....~....~ .......................... 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 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 ..:~...:.=...O:.. Number of Stories ................. ::. ................................................................................................. 9. Size of lot: Front ........... ~ ...................................... Rear .......................................... Depth ................................ 10. Dote of Purchase .............T.....:J ................................... Name of Former Owner ........................................................ 1 1. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning low, ordinance or regulation: ........................................................ 13. Will lot be regraded ...../~..~. .......... Will excess fill be removed from premises: ( ) Yes ~No 14. Nome of ?whet of premise ./.Z~',~..,~,~-f~C~.._________________Z~.,c~x,~ Address/'.~.~..~..~..*'ff...~'¢~.,,~ ~,r~ ~'~one N .~..- .................. Name aT Architect .............................................................. Address ~.~,~F,:~M...~/..f¢ .....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,,.¥OR~,I ~ [ S S CO?_T~ oF .~ ......... r . ......... ....... · ~..,...,~.~)~-~.~. ............................ being duly sworn, deposes and soys that he is the applicam (Name of individual signing contracT) above named. He is the ...................................... ..,-~,,~_~,,,,~r',,~., ,T~.,, ............................................................................................................... (Contractor, agent, corporate officer, otc.) 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 applicction are 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 __ ~ A ...... ........ , ......... , \YZ .......................... ......... , , (S'gnotu e of applicant) Term ExpJrea