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HomeMy WebLinkAbout10370-z FORM 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) U Date ..l.l.~..l.G.~Gl.. ,r G'v!.~.-:.......~~.. 7 9.. N. 103'70 Z Permission is hereby granted to: ~ to ..................J........... at premises located at ~~~~U... .....L... S~r.E+GeC!.~~~1~0 r pursuant to opplication dated 19.1... and approved by the Building Inspector. j Fee i g . \ Buildin ector ~s, i ~ _ ~_r .sL FORM NO. Y TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE 9 SOUTHOLD, N. Y. r r 7 Examined 1977~f... ~ Application No.../.~J. Approved i5i:..~. Permit No. „-~TQ...."....... Disapproved a/c~ 1 . g ~ ..(Building Inspector).. q J'~ APPLICATION FOR BUILDING PERMIT ..-tttJJJ ~ J ~ (j~D „9~ j Date z:..~ 19.1....~~.. . ~ `~{1 r 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 plop 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 Department for the issuance of o 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 far 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 necessary inspections. (IJrf'/t) S'gnature of applicant, or name, i corporation) (Address of applicant) ~ ~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Q..1.~? . N.'~..~~ ..............................s./.............................n..................../.......................................................................... Name of owner of premises ..............~0..(7!~,~.........~~.......4.Q.!~.(:~.d.~j,~.................................................................... If applicant is o corporate, signature of duly authorized officer. ........................................................P.............................. T (Name and title of car orate officer) ~ 5 st(~T t~LUC~ ~ ~ 1- Builder's License No . (~'Cv':^i ~~3 2 (7f=f5'Tr~~ (a `~p~ ~ Plumber's License No . Electrician's License No. Other Trade's License No 1. Location of land on which proposed~--work will be done./~Map~°.~ Lot No......................... StreeT and Number ...'~~~0......v~.~~,Cll.Q~/...~..J.'~G'....\.aril.!...~'C?.~ ....................LirJ.~~.+G.C.1 ,zC/.~..'::~1.. Municipality 2 State existing use and occupancy of pre-~m~/isl~es~~and intended se and occupancy of proposed construction: a Exisiting use and occupancy .........F.!C,f?X..~,... b. Intended use and occupancy .......Y.l.~'-... ............~~Z.ei<:C..I~X.L.G.~.~... i ' I 3. Nature of work (check which applicable); New Building• ........Addition Alteration Repair Removal Demolition.................... Other Work (Description) 4. Estimated Cost .......~..~V.'f.~ :..........................Fee .~7~.,.~ 5. If dwelling, number of dwell (to be paid on filing this application/) ing units ......,5{,,,,,,,,,,,,,Number of dwelling units on each floor . Z'....... If garage, number of cars .......~wO 6. If business, commercial or I, mixed occupancy, specify nature and extent of each type of use ..P~i.~~.~.+q'~r..-. ' 7. Dimensions of existing structures, if any: Front Rear Depth Height Nurrjber of Stories Dimensions of same structur,'e with alterations or additions: Front Rear . Depth Height .............................Number of Stories 8. Dimensions of entire new co nstruction: Front Rear Depth Height Number of ~ries 9. Size-of lot: Front Rear Depth 11. Zone of Purchase ..............................d r Name of Former Owner `O/~/~,.(,~!~~°~,,,/,~~~,~/f,,C2,,, 10. Date or use district in whictj premises are situated ....~ZLYt!©L:{!...~~~ 12 Does ro osed construction t3. Will loP be re raded ~ violate any zoning law, ordinance or regulation: 9 p Will excess fil! be removed from prempises: ( ) /Yes (~No / 14. NName o~ Arch tectemi~~.tiJO1~!`~.. eau oI~ Address :4"~ip1N.L't.h),SJI'CR~..E~:[.Phons No....~~~P.~.4? Akl~.....17.!<.Nb.~ Address .~IJ~K~E.k4.~..N:`1.:... Phone No...~27.,3T~Q. Na Q. me of Contractor (~O~..J.........1~.......,C~.4.:V~~~~~...... Address J4).(~N~..S~.tS1G~.I~,~iPhone No...~~9~P.~~.~4.. PLOT DIAGRAM Locate clearly and distinctly ~It buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and biocl< number or description according to deed, and show street names and indicate whether interior or corner lot ! , I I ~ ) , c~ ~ _I ATE OF NEW OR t COUNTY OF , , ••..,f S.S above na' (Na of individual~si ~ "••••being,duly sworn, deposes and says thgt he is the opplicam gnmg controci~ me He is the (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove performed the said work and to make and file this application; that all statements contpined in this application are true to the'best of his knowledge and belief; and thar the work will be performed in a manner set fprth in the application filed therewith. Sworn to before me this ' day of i.......... 19.~:~ Notary Public County ' i (Signature of applic nt MYRItL tRY l~ j NpT,ARY ?UYUC, SiNe ei New Yor~ Ato. 52.4'52X26 • Suiio{k' Ceunty ~ Coopn;c~io.• SRPINi Maro630, 19...a.w ' - - - - • - - 1,_ - n i L O IIV 5 F~LCi IOi~ I DA ~G I~~~ CO1~-/liV4 r_ !~l 1 S__ -WV.1 i t _1 e ~ _ t a z NA ' ~ - M ~ ~(~;[1, e~ j~ f ~G•/, ti .l:n c+s .l ~ L~~• ~ C. ~i /t f, 2 ~ b C4 ~ 1~L v M I N E, ~ ~ H.~ k~ r.+~ - i ~f 1 1~t S v 1~ T 1 0 1.:t - y •l.1. Y. S'Y.C1 l c ~ ~ E iv ~ 2 c v Con ` E - - - ~I ¢ - -I-~ I ~ - 'C - :r~ _ _ _ r, i~ D t I t tal L C U t~-/l _ N 1 - - ~ ~ _ ~ x v~ - n~ - - 1 _ ----t- i _ ~ 3~~~ a~...-_, t._„_.