Loading...
HomeMy WebLinkAbout12598-z FOEM NO. 2 TO~N O~ $O~THOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 12595 Z County Tax Map No. 1000 Section ..... ~,..~.. ......... Block ...... ~ .......... Lot No.~.~. :...~.?...~..~. :..~ pursuant to application doted .... .~,.,~'~,'~'.~..~...J-.~ .............. , 19,.~..'~., and approv~ the Building Inspector, Building Inspector Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved . .~gYr~.~5~., 1981. Permit No.). ~..~'~..~ .... Disapproved a/c ..................................... Received .......... ,19... (Building Inspector) APPLICATION FOR BUILDIN~ PERMIT Date...; ..,19 . State whether applicant is owner, lessee, agent, architect, engineer, general Regul~)tigns, for the ~onstru/tidn of bufl,~',m~$,~ a,~l~i,~C)ns ,or ~lt~rati0ns, or for remOyal The appjIcg~t: agreeS: t_o compl3/, 'gSfl~ ~lb'at3~ticablg laws, or~mances bufldmg code ~ adm~t~-~d ~pe,c~O~.On pye~mes'and'm bmld.mg f~ necesmw r .... (Mailing address :orpoIaaiion) plumber or builder. Name of owner of premises)$,~.~. 4 ' ' '(as on the tax roll or latest deed) /~. If applicant is a corporation, signature of'duly authorized officer. (Name and ~le of corporat,e officer) ~ Builder's License No ....... ~.~.~ .......... , ~'... ' ' :' ' <" . Plumber s Llcea~, ~ .... ,, , ~,.~ ..,~ .... ,~. ~ Electrician's License No .......... ""~ .... ' Other Trade's License No ...................... 1. Location of land on which proposed work will be done. i©. House Number Street Hamlet County Tax Map No. lbO0 Section ..... a~ ~' ........ Block .... .~ ........... Lot.J~.~..~...~.~., ~,.. Subdivision .~.1..~(.~r~.(~.....~. ~?'~)~..~.~iD .T'. ~'.. .... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of prpp, ose0:,construction: a. Existing use and occupancy ..~. ,~l~.~,~,c~..~'.~'~',~,~, ,~.~.1~'~,~.... ~.~,~q ................. b. Intended use and occut~ancy ,~ ~,.d,/~i ~ ' INSTRUCTIONS a. This application must be completely filled in by typewriter or ij~3ink,~nd,submil;ted:~he Building Inspector with 3 sets of plans accurate plot plan to scale. Fee according to schodule '~, ',' b. Plot plan showing location of !o,t-'~idVo£~buildings. on pr,raises, relationship tc3~fi~i'~ing premises or public streets or areas and giving a detail~, descrip'timi, o,f t~,ouLof,'propei-ty~:faust b~ drawn o~!the diag~'~am which is part of this appli- cation -""· c .... · ' .,' .... ''~ ' ..... ' ' c. T,h.e work ,coVgred by tkis al~pli~ilt~grt may ;~,ot be commenced before issuance of Building Permit. d. 't'~I}~n :approval of this 'apbiieaffon~'~l~e Bc~ildin. gIhgpect, or will issued a Building Permit' {o the applicant. Such permit shall b~i~e, pt on the premises available fo/in'Sp,~ction tli~oughout the work. ' ,', ' e.~ :4~5,'bt~ildigg shall be occupied or used in whole or in part for a,ny purpose whatever Un~il {t.Certificate of Occupancy shall ha~ b~n'gra~ted by the Building Inspector. ' ' .':. '.;. · ~, , APPLiC, A,TION IS HEREBY. MADE to the BuIldmg Departmerlt for ,the ~ssuanc~,:~.~dlng Permit pursuant to the Building Zone Or~hnance of the Town of Southold Suffolk Coun41/,,New York, and O~]~er al~pllcab!e Laws, Ordinances or as herein described. gu~ation_s, and to 10. II. 12. 13. 14. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Wo r k~. ~,~ ~/.~.~l~. .~. 4/~., (Description) Estimated Cost. .~, llt.~ ................... Fee ...................................... (to be paid on filing this application) If dwelling, number of dwelling units ..... ~ ..... 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 structures, if any: Front ............... Rear ..... ,._. · · ... · · Depth ................ Height .... ~?. f~.~..~. ~ .-ff'~.*~e,~.~4~.. ,~/~.... ~.. ~'~.~..~...~,e~,~.~-'. .... Dimensions of same structure w~th alteratmns or add~bons: Front ................. Rear .................. Depth ................... i'" Height .. ~'",~,1~,,, .......... Number of Stories ...................... Dimensions of entire new construction:-7.r.~nt .~b~v,.l~ ..~t/..~A~'e~,4r~(~.. ~.~ .* I;~ ............... Height ............... Nu~nber of Stories ........................................................ Size of lot: Front . .~,~.~ ~,J[~. ~... ~ ...................... I~ ..................... Date of Purchase .~. ........ Name of Former Ow_ncr Zone or use district in which piemises are situated... ~.t~,.~. J...~...~s~, ~ .............. ,.. ............ Does proposed construction vi~ ,late any zoning law, ordinance or regulation:,/P~.~..~.~e. ~'.. Will lot be regraded ....... ~ ....... Will excess .fill be removed from premises: Yes ~No~ Name of Owner of pr~emis~s ~.~.',~ i~.i ~.' ~t~'_/.~ltgss .. ~.~e~.. ~Phone No.,J~.'.~.~'. I~ ~.._~..~* ~.. ~ss ~,11/,,,./,.~11~ ....... Phone No.,~J.-'.~,,~. ~.1~.. 16~.. ,,FE-,~_ ?~*~,' . ..... ~.~'. ~.~ ~,~, .~,..,~ll~l~s~,4~... ~J~.~.~*~/~hone No ................ PLOT DIAGRAM ned the said work and to make and file this the best of his knowledge and belief; and that the filed therewith. LI,NDA F. KOWAL~iKI NOTAR~ PUBLIC, State of Now York . . .~ i No, 52-4524771 pplicant) (~u~lified in Suffolk County /- Commission Expires March 30, 198t. p'C