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HomeMy WebLinkAbout9740-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDllqG PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Date ........ Ma.~ ....... 2~, ............................. 19..78.. Permission is hereby granted to: ......... Matt £t,~ c~...~undowm ..Inc ~ .................. to ............ e~ect..a..~ence. ................................................................................................................ at premises located at ........................ .1.~(~.0.....~aJ.;l:l..RO~([ .............................................................. ........................................................... M~t~4Lt:u~k ~.. lfe~..Yoz, lc ....................................................... pursuant to application dated ....... ~ 22 _ . ...................... , lg...'ir..~., and approved by the Building Inspector. Building Inspector TOWN OF $OUTHOLD BUILDING DE~RTMENT TOWN CLERK S OFFICE ~UTHOLD, N. Y. Disapproved a/c ................................ ,'..,..~u ....... '~':~. ~;.; ................................... (Building Inspector) Application No ................................ 9700 APPLICATION FOR BUILDING PERMIT Date .,././. :~.~/.. ~?'~:. ............. , INSTRUCTIONS 7":' a. This application must be completety 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 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 a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION iS HEREBY MADE to the Building Deportment for the issuance of a Building Permit pursuant to the Bud n Zone Ordinance of the Town of Southold, Suffolk County, New Yorki and other applicable Laws, Ordinances or Regulatgions, 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, end regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. .... ..... ,(Signature of applicant, or name, if o corporation) ? --') , --, -? *~..~ ............. s*......~ ............ :;......~.'~ .............. · .......................... ~.... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..................... ....................................................................................................................................................... Name of owner of premises .............. ,~:.k:!:~:::~. ....................................................................................................................... < if oppJicar'~t) is a cqcDora*C~, '~ignature of ~uly authori=~d-officer, ..... ........... (~ame and title of corporate affiX) / Builders License No ................ (?,:.:'...;.;~['.../.~: ......... Plumber's License No ................................................. /000 - II //- Electrician's License No ............................................. Other Trade's License No ............................................... Locat on of land on which proposed work will be~done. Map No.: ...... ct'.: .......... ~' ...... ;~ ............ Lot ~o ......................... r /~2/,,/.. t('x~//,\) /~/?-/., ,,/)("Z /,J // Street and Numbe .../~. ....... !:..~;~.....' ......... ;;..:.'~: ................................ : ....... ~ ....... ~ ...... : ......................................... Municipality State existing use and occupancy of premises and in~,ended use and occupancy of proposed construction: e. Exisiting use and occupancy ................................................................................................................................ b. Intended use and occupancy // 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ................ Demolition .................... Other Work Repair .................. Removal ............ ~.. ~'~ / ~ ~,t¢/,_,_~ d)~ (Description) 4. Estimated Cost .......................................... ee .......................................................................................... (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 ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated .................................................... ~.~ .......................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded .......~).~ ............... Will excess fill be removed from premises: ( ) Yes (,~) No 14. Name of Owner of premises ./[~vY~.r.~,~;(.~...~)~/~..~Z~'Address ....¢4~.~,..l~.~' ' ' ' ....... 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-~ck dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner Iol. STATE OF/NE{W,) 'YO,~I¢, COUNTY PF :':':'..:::-¢-/¢:;!¢.;...x/~..qz~ ............. t.~..[~;'.(./.:(.r.c...~... ........ }q¢~.~;~ ............~ ................... being duly sworn, deposes and soys that he is the applicon, (Name of individual signing controcf) above named. . ...... ...... .......................................................................................................... kle is (/ ~ntractor, 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 are true to the best of his knowledge and belief; and thor the work will be performed Sworn to before me this //, f / ) ~ // ....... ......, ...... ......... ....................................