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HomeMy WebLinkAbout7766-z TOWN OF $OUTHOLD~ TOWN CLERK $ OFFICE SOUTH'OLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI~MISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ~T? 7T J~ J$ Z Date ........... ~ ........ ?.J/~j~..~...~j~ ......... , 19.~.. Permission is hereby granted to: l?.~.~M.,...g.O~'g ................................. :.:.,.. ............. : ........... ......... ...................... .............................. ~t~ ......................... at premises located at ~.~.~...~'OL~S..~r~ ......................................................................................... ................................................. o.~thol~ ......... ~.~o ......................................................................... pursuant to application dated .................... }[a,~.~?~....~....~.~.,i....., 1~.~...., and approved by the Building Inspector. Fee $].~.e..(~. ............. Building Inspector SOUTHOLD, N. Y. Examined .................. : ..................... Approved .................. !.! ........ ...~.....~..., 19.~.~.. Permit No....~...~.....4ff.,..~.. TOWN OF SOUTHOLD ~.~//-./~q,;/~ . ,q. ff'~/'~--, ~, , ~ BUILDING DEPARTMENT ~ v~ ~ ~/' ~7 /-~ ~//~/ ~ TOWN CLERK'S OFFICE :~ ~ ~/ ~ Application No....~.'Z...~..~ ....... 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 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings an premises, rdationship to adioining 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 ir~ buildings for necessary .i~n. spections. (Signature of opplicont, or nome, if a corporation) (Address of applicant) (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. State whether applicant is owner.,~lessee, agent, architect, engineer, general contractOr, electrician, plumber or builder. Name of owner of premises ........ /,:??.,...~.../.(....5:':~:.~...'::'/~'~'"'"'"'J' ......................................................................................................... If applicant is a corporate, signature of duly authorized officer. 4,. Electrician's License No ............................................. Other Trade's License No ............................................... Location of land on which proposed work wJJI be done. Map No.:., ........................ ~. .... Lot No ....... ..~... Street and Number :.~.-../~....e. ~:.~j~.o.......~.~....4~.'~. ....... .~:.~:..~.&..~:.~ ............... '"~ ............ Municipoli~ State existing use and occupancy of premises and intended use and occupancy of proposed construction: '"7 '~ '~ ~c . .....~ a. Exisiting use and occupancy .......................................................................................................... ~/ ~ ~.' ............. b. Intended use and occupancy ................. ~_.~_:. ........................................................................................... 12. 13. 14. I Nature of work (check which applicable): New Building-. ................. Addition ...... .~, ...... Alteration ............... Repair .................. Removal .................. Demolitior, .................... Other Work ...~..G.~.~.:~" ......................... ~:/ (Description) Estimated Cost ............................................................ Fee (to be paid on filing this application) If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, number of cars ............................................................................................................................................. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 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 ................................ Dimensions of entire new construction: Front ................... , ................ Rear ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................... Size of lot: Front ........................................................ Rear .................................... sZy..~Depth .............. (~ ~,;U ............... Date of Purchase ........................................................ Name of, Former Owner Zone or use district in which premises ore situated ............. ..~....;:...~'. .......................................................................... Does proposed construction violate any zoning law, ordinance or regulation: .~,.0. ................................................ W'ill lot be regraded . ......... ..~.~...,~..~ ..... Will..)excess fill be removed fr,.o~ premises:,.( ) Yes ( ) No Name or' .............................................................. Address ....................... :;~...'r:. -rhone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing 9~ proposed, and indicate-all set-back dimensions from ~rty lines. Give street and block number or description ~cording to deed, and show street names and indicate STATEOF NEW~¥OR(, -- COUNTY OF . '~'(,'"~-'¥"~'///--'73 ~-S.S ................. ~/~:.....~([~ ~,*/1 4¢ ............... i~.."~.~! ',~_ ~ ~.KI O .................................... " . ........ being duly sworn, deposes and soys that he is the' applicam (Name of individual signing contract above named./Z, / He'~l.~ the ....... ../}f...~.c~"~c-~ ........................................ , ............... .1 ......................................................................................................... " (Contractor, agent, corporate officer, etc.) of scdd 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 ~pplicotion are true to the best of his knowledge and belief; and tk, a~ the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this '~..,..,.-~... day of '~'1.,4 .o.:,,..c~ , 19'?'~"~'~,'~ 'i~;;;~"P~'~l'i~i'. ............ /il.'/iii~Z(;;i/i'~'~unt~/ ..... . ........ : ............ :~"c'"-~"~'"?'"'"~;:~"~:"("~:'"~"~"~'"?'(Signature of applicant) ................