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HomeMy WebLinkAbout9851-zTOWN OF $O~TSOLD 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) Ne 9851 Z Permission is hereby granted to: ........... 2....,6,..., 5.....Cox~¢~.~,~ .o.m ~,..e_ .z:~..**:],~ Co~,. ........... a~.c.....l~t:Lchola~..~ldea .................... at premises located at shove Road ................................................. G~.. e~lao~d;,...N~'~...¥e~.~ ....... :2 ......... : ....... } ......... ,...~ ....................... 2, ~ 22,. , A~ ~ P~o~o:~a~e~. F~ed ~ap ~. pursuant to application dated ...... ~,...J~ ......... :.:..,..;;,..~, ,.~., 19~ ~} ahd approved by-, th~ ,:~ ::,: Building Inspector. PERMIT iNCLUDES APPROVAL TO REMOVE EXCESS FILL FROM ABOVE PREMISES RF. GRADING LoT DRIVEWAY CONSTRUCTION CESSPOOL CONSTRUCTION CELLAR C©N~u~TIOI~( OTHER FOI~M ~0~ ~ TOWN OF SOUTHOLD BUILDING DEPART/~ENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. NOTICE OF DISAPPROVAL / // ..... ~.~..: ........ ~,,...,~; ...................... ~or permit to~oBstr~ct~.~~....~t the ~re~is~s located ~t~.~.= ................... returned herewith and disapproved on the following grounds .~..;...~.~..~. uifdffig Inspector t - 0 ~OBM NO, 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 9851 Disapproved APPLICATION FOR BUILDING PE~IT INSTRU~IONS a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Building Impecter, 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 o detailed description of layout ofproperty must be drown on the diagram which is port of this application. - c. The work covered by this applii:'ation may 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 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 Departm(mt for ~l~e issuCnce 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 buildingsj additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, ,J~,ilding code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necess(a~ inspe~1~ions.,~ ........ ............................. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, -architect, enDineer, general car)tractor, electrician, plumber or builder. applicant is a coq~orate, signature of duly authorii~d at'ricer. (Name and title of corporate officer) Builder's License No .'~, Plumber's License No ................................................. Electrician's License No ............................................. TO REMOVE EXCESS FILL FROM ABOVE P[~EMIS[~$ P,¥ REGRADING LOT ~ DRIVEWAY LON~TRUCF[ON CESSPOOL COHSTRUCTION CELLAR CONSTRUCTJ~M ~ Other Trode's License No. ,...,Z:.~.7...?...~.,.~.~.! ..................... Location of land on which proposed work will be done. Map No.: ,: ...... I.[..~ ~-~ i..:.,i ........ Lbt,No. ) ,2- Street and Number ...,1...~,.,~,.'~......~..,~,.,~,..,~..~,o~, ,~...,~. ...... ,/~.,?., ............... 6:..,.t~,~,%>:~..~_,,,O....z~..:.,T. ............................... Municip'afity State existing use and occupancy of premises and ~ntended use and'bccupancy of proposed construction: a. Exisiting use and occupancy ................. .~..;.~...,:~.. ............................................................................................... b. intended use and occupancy ............... ~L~(~¥~`~`?~`~?~?~--~/~-~?~?~?~`/~~- .................. ......... ~n applicable): New Building~ ...~.9..-~-...,Lr... Addition .................. Alteration Repair .................. Removal .................. Demolitior, .................... 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 .......................... i: ..................................................................... ,~ ........................................... 6, If business, commercial or mixed occupancy, specify._noture 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, D mansions of entire new construction: Front .[ ............. ,,r~.~.. .............. Rear ..........,~...~.. .......... Depth ........................ Height .................... Numbe at 5t r' s 9. Size of lot: Front ....................................... /../.~.~. ......... Rear ...... ./.../;.~.. ........................... Depth ,./..~...7... .................... 10, Date of Purchas'~ ...... L: ......... i ..................................... N~me of Former Owner ........................................................ 11. Zone or use district in which premises ore situated ................ .~,.,..~.~......~.. ..................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ......... ,t~,..?. ....................................... 13. Will let be regraded . .......... '.t~..",,?.. ....... Will excess fill be removed from premises: (::~ Yes ( ) No 14. Name of Owner of premises ....~..,.I..~,~...o.~..~ ....... ~.P..?,.~.,~..,~...' Address .~.~.J,,/,~'..t'.?~.....i..~...,/,./O,../?~oPne No. ,ff.,7,,~.' .......... Name of Architect .............................................................. Address ................................Phone No. ...................... N~me of Contractor .~'.~.°.,~.),,9,.~Z.....~,,°..°...,%.~. ..................... Address ..'~,..e't.},..~..~.,~,.~..~..~/.~..q.~ Phone No....~.,.'/.....~,.2,6..}./.. PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate oil set-back dimensions from property lines. Give street and block number or description according to deed, and show street names Qnd indicate whether interior or corner STATE OF NEW3~ORY-, -- , icc t , . COUNTY OF ..,.,~?,...q.,~.,..tE, EO.~..~..,f~'"' , ..................... .~,~,~.~,.:...~.~Z~.~.).~.~, ...... ;,: .......... being duly sworn, deposes and soys that he is the applicam (Name of individual sig~ling cbntracf) " ', ~ ? ' ~x, , ~ Y ~ above named. He is the .................................................... ~.~.,~,~ ................................................................................................. (Contractor, agent, corporate, officer, otc.) of said owner or owners, end is duly authorized to perfor~ or 'have performed the s~id work and to make and file th s application; that aH statements con~oined in this application ~true t~the best ~ knowledge and belief; and tha~ the work will be performed ih the manner set'fb~h in the appli~ati~ fi~dlthe~. ~ Sworn to before me this I ~ I I ~ ......... ............. of ...... f'"'"ZZ ........................ ' ..... Nota~ PuNic, ._...~...~...~...Cz ........ ~ ............. Coun~ ..... ~f ........................ ) ~ L~gnature o appnc I