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HomeMy WebLinkAbout9745-z FOI~M NO. 2 TOWN OF SOUTHOLD 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) N? 9745 Z Permission is hereby granted to: .................. ~.t..z...z..t..~..,~.,.....~.z....~..~ ................ ~1095 Main Road at premises located at ............................................................................................................................ Cutc.h.p.~..,.e~ New York pursuant to application dated .......... ..~...8:..~. .......... .2.../4.. ....................... , 19...7../~..., and approved by the Building Inspector. Fee $....JJS,.O0 ........ Building Inspector 1000-102-2-2~- FORM NO. 12 TOWN OF SOUTHODD BUILDING DEPARTMENT Town Hall Southold, NY CERTIFICATE OF COMPLIANCE ,, ~ Date ....... ~ l~ ~./-~fT~,-- THIS CERTIFIES that the ..~ .mm_ P Location of Property ~/ {3~7~C ~ f~ ~g~ ..... Co~ty Tax Map No. lO00 Section / ~ ~ Block Subdivision .... Filed Map No. Lot No. confo~s subst~tially to the Application for a pe~it heretofore filed in this office pursuant to which ~-~/~ ' Pe~tt No. ~ '/_ /_~ated_. //" ~. ___, was issued, and confo~s to all of the requirements of the applicable provisions of the law. ~e certificate is issued to ~'"' ~ ~>~'rt 4/80 Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ............ ..~..8..~ ........ ~../-I:. ........ , 19.....7...8 Permit No ....... .?..7...~..~Z. .................. {Building Inspector) Application No. 9745 APPLICATION FOR BUILDING PERMIT 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 a Certificate of Occupancy sh~all 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 necessa/~ inspections. ........ ................................... (Signatu e of applicant, or nan~r, if a corporation) ........................... .............................. State whether applicant is owner, lessee, agent, architech engineer, general contractor, electrician, plumber or builder. .............................................................. '; ......... ;";'""; ............. ........ Fz"/ ...... 7'": ............................................................. Name of owner of premises .............. /,,.,.,,~.~ .............. ~..~.1. ................................................ ,,f ........................................................ / 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 ............................................... Locotion of Iond on which proposed work will be don.e;~ /~op I~.o.: .~.....? .............................. Lot No ......................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: e. Exisiting use and occupancy b. intended use and occupancy ........ ::~.,~..;..Z.'. ...... ~.f/..~......./.~.. ....... Z;?.....: ..... 3. Nature of work (check which applicable): New Building.. ................. Addition ............ .;;~.. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work .........~.:.~.~/..~....~ ~ .................... .... f / (Description) oO A. 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 ....... ..~..../. ..... 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, n //premises: ( ) Yes ( ) No / 14. Name of Owner of prem,ses ..¢,~.~..r..~/.. .............................. ./..... Address ............... , ...... Phone No. Name of Architect ............................. =~.., ........................... Address ................................ Phone No--.7 Name of Contractor k' ~/7~'~, ~" .............................. : ............. ~/ ............ Address ................................ Phone N ...................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fram property lines. Give street and block number or description according to deed, and show street names and indicate ~vhether interior or corner lot. S-I-AntE OF NEW Y~)RK~// ~ ,/~ ~ ~ ~ · ' ~7 / coo¼,,-- OF ;/ ' .. ............. ....... ~.~ ............................................. being duly swam, deposes and says that he is the applicam (Na~vi~ning contracf) above named. He is the .......... ~ractor, 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 ~his app cation; that all statements ~contained in this applicat)on are true to the best of his knowledge and belief; and tha~ the work will be perfo~ed in the manner set fo~h in the~pplication filed therewith. Sworn to ~re me this / ...... o, ................... , ............... co.. .......... ............ .....................