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HomeMy WebLinkAbout9570-zBUILDING DEI~ARTMENT TowN' CL~R~'S OFF',CE SOUTHOLD, N~ ¥. BUILDING I~ERN~,IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9570 Z Permission is hereby granted to:~ /~ ~'"~ -- pursuant to application dated ......................... .Q.~.........t-x~.........~..~...: 10........') ?., and approved by the Building Inspector. Fee $.]. ..................... BuildingI nSPect:or TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFICE SOUTNOLD, ~. Y. Examined "% , .......... ~proved ...................................... , 19 ........ Permit No ..................................... Disapproved ~~ .~~~.~ .~~ ...................................................................................... (Buildin~ Inspector) Application No ................................. A"PLICATION FO" BUILDING PERMIT Date ......... ~....¢~.....j~ ................ , 19 ............ 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 adjoining premises 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 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 o Certificate of Occupancy shall have been granted by the Building !nspector. 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 regulation, a~d to admit authorized inspectors on premises and ir~ buildings for necessary inspections. / / ~ ~ .... :....:.'.. .: ........ L...~..i.:~...L.< ............. :.....,~/. ................ ,/"(Sig,l~Sture of applicant, or name, if a cor'C'oration) ...... -.......,,.?:. ............ :: ............... · .......... ............... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor~ electrician, plumber or builder. ........................................................ ...... ............................................................ Nome of owner of premises .......... ..k~.......F.... ............. }~ ...................... ~ ................... L ................................................................ / If applicant is a corporate, signature of' duly authorized officer (Name and title of co~orate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... ;~.~_ ~,. Location of land on which~grjl(;~esed work will be dorte. Mop,No.: ....,41g .......... .~ ................... Lot No ......................... ,, , ~/~ /~/~- ..... ~. ~ U~-~ ~ ..... Street and i~umDer ......... ~ ....................................... ~.~ ............................................................................................. Municipali~ State existing use and occupancy ~re~ises,,and intended u~e g~ld occupancy of proposed construction: b. Intended use and occupancy ...................... :::.~ ............... :.....J~..~.:..~ .......... ~.:'.....~ ........................................... / 3. Nature of work (check which applicable): New Building'. ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolitior ..................... Other Work ........ ~ ~:~'~ i~?~:i~'i ........... (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 .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ................................................... ,.v..Nam,e of Former Owner ........................................................ 1 I. Zone or use district in which premises are situated .(~.:.~ ...................................................... · ..................................... Nome of Contractor ... ~::~¢'~'~"~-- Address ................................ Phone No ....................... PLOT DIAGRAM ~ocate dearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from prop~.rty lines. Give street and block.,g?~b/~ or descrri?tion according to deed, and show street names and indicate whether interior or corner lot'. ~.,/~(~-~ ATE OF NEW/YOF~,, ]~1~' / c ¢ COUNTY OF ..~%/~E~.~..'m..A...f~'" ............................. .~..~_/.~4~.~'~ ,.~.,-.:,~..~.~'.~.,.,.~..',~,..~::.....~[.....~..)ZC.~..being duly sworn, deposes and says that he is the (Name of ifi~ividtlJa[ signing co&tract) above named. Fie is the ................................................... C~' ............................................................................................................... (Contractor, 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 fib' this application; that all statements contained in this application are true to the best of his knowledge and belief; anJ set forth in the application filed therewith. they the work will be performed in the manner ~- -~.~..-f~/~ ~, ~/P""r'-"~--~'~"~~ ~~ Sworn to before me this ~ ................ .... Notary Pt County .,~,., ............ NOTARy State of New York No. 5 term £x~ires March 30, 19~'.~ BUILDING DEPARTMEH'I' '~ b/ Examined . L~ .'3---- 19..?...~ Application No. ~ ~ 19..?.?.. Permit No..~..~....~....O...~.. Approved ......................................... . ......... Disepproved a/~.............~.~.. ~........~ ................................................ ............ ...... .. ................ , INSTRUCTIONS o. This application must be completely filled in by typewriter o~. in ink and submitted in triplicate to the Building Inspector, with 3 sets of pi=ns, 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 o detailed description of layout ofprOperty must be drown on the diagram which is port of this application. c. The work covered by this application mc~ not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue o 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 port for any purpose whatever until o Certificate of Occupancy shall hove been granted by the Building Inspector. APPLICATION IS HEREBY AAADE to the Building Deportment for the issuance of o Building Permit pursuant to th~ Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lows, Ordinances o~" Regulations, for the construction of buildings, additions or alterations, or .for removal or demolition, os here n described. The applicant agrees to comply with oll applicable.lows, ordinances, building code, housing code, and regular ons, land t;~'-,~ admit authorized inspectors on premises ~nd in bulldlngs for necessary inspections.. "' i i ........ .......................... ............................... Builder's License No. Plumber's License No ................................................. Electrician's License No ............................................. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is c corporate, signature of duly authorized officer. (Name and title of corporate officer) Other Trade's License No ............................................... Location of land on which~/~. ~,1~ ' ,/'7/lpr~p°sed work will be done. Map No.: ....../~/, ____~'~ ............. ~ [ ................ Lot No....~. ................... Street and Number .... ./.~/f.v~........~....,Z'.~ ...... ; .~....,,~.....~....c~.. ................................................ Municipality State existing use end occupancy o~f,f premises and intended use and occupancy of proposed construction: o. Exisiting use and occuponcy~...~...,..~..~..:....~^ ! // ................................................. b. Intended use and occupancy ......... i~ ". "......~..,~...~.~ ~r ......................................... ,.. / 3. Nature of work (check which applicable): New Building.. ................. Addition ............ ~Alteration Repair .................. Remaval .................. Demolition .................... Other Work ........ ~..~..?.~....~ ................... (Descril~tion) 4. Estimated Cost ............................................................ Fee ...J..~ ................................................................................. (to be paid on filing this application) 5. If dwellT~g, number of dwelling units ....... ./. ................... Number of dwelling units on each flear ............................ 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 .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ................................................... rv..Nam~e of Former Owner ........................................................ 11. Zone or use district in which premises are situated .~.:.~. ............................................ ~ ...................................... 12. Does proposed construction viqlate any zoning law, ordinance or regulation: ........................................................ d be regroded. ........ fr ho,m ses: C ) Yes ( No 14. Nome of Owner of prem,ses .~........~.~....~.. ...... Add,, . .~'...~.. ....................... 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~,~', or de~i~.ti~n according to deed, and show street names and indicate whether interior or corner lot. ~'~-~ C~- ATE OF NEW,,Y{)~,. ~) ~S.S COUNTY OF above named. He is the ................................................... ~ ........................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to ~ke and file this application; that oll statements contained in this application are t~e to the best of his kn~ledge and belief; and that the work will be performed in the manner set fo~h in the application fil~ therewith. Swam to before me this ~ ~ // / / ~~~ / Nota~ P~c,. ......... ~ ...... C~n~ ~~~~ ............... ~/_ . ~ ~ ~ ~ ~ ' ~ (Si~at~ applican~ Term ~re*