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HomeMy WebLinkAbout11647-z FORM NO. 2 TOWN OF SOUTHOL,D BUILDING DEPARTM£NI~ TOWN HALL SOUTHOLD, N~. ¥. BUILDING PERMIT:, (THIS PERMIT MUST 13E KEPT ON '~H,E PRE/ViIs UNTIL FULL COMPL~I'ION OF THE WORK AUTHORIZED) Perm ssion is hereby granted to: -,- ~t No..~.~ ....... .,~and ~pproved by the FIELD ~NSF~CTION 1. FOUNDATION (1st) FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY C,ODE FINAL COMMENTS ADDITIONAL COMMENTS: ' ~.~;, o," ~ :' ' "':::::'"'?..... .'.::':":"..''~ .::'~..:".: ": '.:"~ :~ :': ' /~.t~, 0.& 'FOR APPROVAL OF CONSTEUC~ON ~NLY .' - '_'. . ' ' - . ~ ~t~~ , D~T~ ~IS~ ~Y~M~ ~R THIS -- : 4~ DENCE Wl~ CONFORM TO ' m~ , OF H~LTH. 5~ ' ' ' ~ ~'~ ~m ......... ~ " -, .. ~' . ..... .., % ~ ,. ,,,. ~ ~,;, ,- ,. '.. FORM NO. 1 TCWN ©F SOUTHOLD BUILDING DEPART*'¥iENT TOWN HALL SOUTHOLD, N.Y, 11971 TEL,: 765-1802 u.~,,,in~d ~/5//~sF'.//. ...... ,19~'.~.~'''' Appro,'ed ~.~..~....'/..., 19....~.' .~Pe rmit No. .........../'/r Disapproved a/c ............... ~ ............. (Building Inspector) APPLICAT1OIkJ FOR BUILDING PERMIT Date A.s... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Build 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 stre or areas, and giving a detailed description of' layout of property must be drawn on the dia~am which is part oP'this ap: cation. e. The work covered by this ~pplication may not be commenced before issuance of Building Permit. d. Upon apprc.'al of tiffs application, thc Building Inspector will issue a Building Permit to the applicant. Such per:, shall be kept on the premises available for inspection throughout the work. e. No buildk~g shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Oceupar shall have been granted by tbe Building lnspector. APPLICATION IS HEREBY MADE to the Building Department for th~ issuance cfa Building Permit pursuant to Buildin~ Zone Ordinance of the Town bt' Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulatious, f.or the construction of boildings, additions or alterations, or for removal or demolition, as herein desc, rib TEe applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in buildings for necessary inspections. /-9 J_ (Signatnre of applicant, or name, if a corporation) ~. A'~, ./f.~x /~-,~x ,.x'~,~-//,~,o (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build Nmne of ncr cfi Irises ow ~rc~ .................................................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly attthorized officer. (Name and title of corporate officer) Bnilder's License No.. ,)(.(. './~.../~.~../.~..577f(~. Plumber's License Ne. ...... Elactrician's License No.' ...................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done ................................................ g. .... ./e..7..~ ......... ./3..q.z../?..~./-.. ~.~.. ~,~,~a/ d_.e.,,?.q(9. .... House Number O 5_(~ S tree t Hamlet O County Tax Map No. 1000 Section/5..~././.~./?..~. ./.?././~./.~. Block ....O..ET ........... Lot Subdivision ~. ................................... Filed Map No ............... Lot ............. (Name) 2. State existing use and occupancy of premises and intended usq, and occupancy of proposed construction:, a-Existinguseandoccupancy .~. .... ~/. ~ff.Q. .~Z¢. ./.q.A/; .~. .~./.~. FC. .-. .Q~ ~ .~. . , ~.t(~ '::/ovd/.'//~z ............... -. b. Intended use and occupancy ' ........ Repair .............. Removal 4Estima£ed Cost . .~-. .................... If dwelling, number of dwelling units ...... Nature of work (check which applicable): New Boilding .......... Addb/ion .......... Alteration ........ .... Demolition ............ Other Work r~...~.CM, tna~.. (DescriptI6n) ............ Fee . ....... ....... ......... (to be paid on filing this application) ........ 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 stmctlures, if any: Front ...... ' ......... Rear .............. Depth. Height Nt tuber et Stories Dimensions of same structure with al{orations or additions: Front ................. Rear .... " ...................... Hm~t'o ............... Number of Stories ........ Dimensioas of entire new coflstmction:~-c . . ~.((f~ . ~e~. .lfl.~ ....... v,h . Height ~. ~.(.......NumberofStories ' 9 Size of lot: Front ' Rear Depth ~0. Date o'fPurchase ........ ~ ................. t... Name of Fommr Owner ..................... [I. Zone or use district in which premises are situated ........................... ?. ........ 12. Does proposed constructio ~ 9 o ate any zonin*law ordinance or root lation' ~ ff~ ..... t3. ~ U et be r~g~aded K ~ff ' ' . . Will excess 'I ' ...... ,~> ...... _: ......... . fl 1 be removed from premises. 14. Name of Owner of premises ~ ff~.. ~qt 5~(~. ·. Addresffeg~ ff a eY.4q. W~ Phone No Name of -krchirect ~ ' Addres~ Phone No Name of Contractor ~ S~ Address Phone No PLOT DIAGRAM Locate clearly Nd distinctly all m ildings, whether existing or proposed, and. indicate all set-back dimensions fro ?roperty lines. GNe street and block number or description according to deed, and show street names and indicate wheth ;r~terior or corner lot. / ~TATE OF ?,JE~,K'~RK.~ / ~ ' S coutureS. a''' ' :, ~~1 sid - .... '~~ ......... being duly sworn, deposes and says thee is the applica, ~OV'. ~alnud. ' ~e is the (Contractor, agent, corporate officer, etc.) o.~ said Owner or own'em, and is duly authorized to perform or have performed thc said work and to m~e and ~/~plication; that all statements eon'rained in this application are tree to the best of his knowledge and belief; and that t~ W'ork will be performed in the mantlet set forth h~ the application filed therewith. ~worn to before me this ........ .... ......... ~ - ' ~ ' -~ , ] ~ PUBLIC' S~ :~:~:.. '.~ ;~.:,.' , ,....,~. ~.:. ', '. ,~ ~.[~L~?~. .' ~ . , :. ~ ,. .-. ,.' (Signatureofapplican