Loading...
HomeMy WebLinkAbout10418-z FORM IgO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N,. Y. BUILDIHG PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 10~18 Z Permission is hereby granted t~o: / - ............................................................. : ..................................................................... ~ ............ :.:..../.: pursuant to application date .......... , 19 , ~nd approved by the Building Inspector. ~uilding Inspector FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examinel~*~4C.ff~..q~.~ .... , 197.? Application No .................. [ff ~ , (Bufldiffg Inspector) ~/fi/~ ~ ¢ / /INSTRUCTIONS a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate [o the Building Inspector, with 3 sets of plans, accurate plot plan to sc~. Fee according [o schedule. b. Plot plan show~g location of lot and of buildings on premises, relationship [o adjoining premises or public streets or areas, and giving a detailed description of layout of prope~y must be drawn on the dia~am which is part of this appli- cahon. c. The work covered by this application may not be commenced before issuance of Building Peril fi. Upon approval of this application, the Buildh~g Inspector will issue a Building Pe~i[ ~o ~he applic~L Such pe~i~ shall be kep~ on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part fo; any pu~ose wha[eve~ until a Certificate of Occupancy sh~l have been granted by the Building Inspector. ~PLICAT1ON IS HEREBY MADE [o ~he Building Depa~ment for the issuance of a Building Pe~i~ pursuan~ Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Re~lafions, for the cons[~ction of bulldogs, additions or ~erations, or for remov~ or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, ~d admit authorized inspectors on premises and in buildings for necess~ inspections. (Signature of a~plicant, or name, if a corporation) (Mail~g address of applicant) State whe~er applicant is owner, lessee, agent, architect, engmegr, general contractor, electrician, plumber or builder. (as on th~ tax roll or latest deed~ If appli~t is a corporation, signature of duly authorized officer. ~- (Name and title of corporate officer) Builder's License No ...... .~..(~ ............... Plumber's License No ..... %..~ .~..~...~..~.~. · [t Electricmn's License No ....................... Other Trade's License No ...................... ~f/ 1. Location of land on which proposed work will be done .................................................. , .... ...... ........................................... House Number Street Hamlet County Tax Map No. 1000 Section ...... I .O. ~ ...... Block ...... [ ........... Lot...[..~ .............. Subdivision. t{Jv¢. ~..~-./-'J,~).. ~]/(.e ~ ........... Filed Map No..~./.7)~ ........ Lot . .~-../ (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... ~.. %.k.71 ~. .,.. b. Intended use and occupancy ..... ................. 3. Nature of work (check which applicable): New Building .... ~(. .... Addition .......... Alteration .......... Repair .............. Remoyal .............. Demolition .............. Other Work ............... (Description) 4. Estimated Cost ....... ~(2L rq-~.i,,~ {Z)~ Fee .~..~_.--,~--( (to be paid on filing this application) 5. If dwelling, number of dwelling units ..... 2[ ......... Number of dwelling units on each floor ................ If garage, number of cars ..... ~ ...... 1. ........................................................... 6. If business, commercial or mixedl occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structure~, 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 .. ~ r,..-~% i.~ ..... Rear . ~,~J: .q.~ 7.... Depth . ~ .~..* .c9 ...... 10. Date of Purchase ........... ! .................. Name of Former Owner ............................. 1~2'.Does p'roposed co~nstruction viol}te any zoning law, ordinance or regulation: ............................ 13. Will lot be regraded ...... ~,.~!.~ ................. Will excess fill be removed from premises: Yes 14. Name of Owner of premises( .t~.. ~1~.~ ~'c~ .... Address ................... Phone No ................ Name of Architect ...'4',~'~ '~.{.[.~ .............. Address ................... Phone No. ~ .............. PLOT DIAGRAM Locate clearly and distinctl.y all ibuildings, whether existing or proposed, and. indicate all set-baak dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. - STATE OF NEW ~ORK - , ' (Name of individuaq signing contract) above named. He is the ................ ,.. ~. .........,..~ ..., · ·/. · · ,. · .~ ....... (Contract6i/, ffg~nt;~orporate 6fficer, 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 gll~ statements contained in this application are trde' m, ~he best of his knowledge and belief; and that the wartt will be performed in the manner set forth in the application filed therewith. Swcf~n to before me this ........ c:~.~. .......... day o~ ....... 19...~ county Notary,Rublic,.. .............. i ....... ',,,,- _ , , .... , ~ No 52 8~uffoIk C~ty~ / I t '~ at oInnmmant~ ~ t~m Expires March 3~, 19~ , being duly swo/cn, deposes and says that he is the applicant FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y, 11971 TEL.: 765-1803 Examined ...... 7 ..... , 19 e~¢~;[~. ~ g~. [r-'~<3/ ~O-~F~'t-/-tc Application No. 4~ ........ Approved~...~ ...... , 1~ Pe~it No./~Z~.. ~ /~ ~ ' ~/~[Vq ~' r~CTI ~ , a. Bmld~n Inspector, with 3 T~s application ~us~e com~etely filled in by ~pew~ter or in ink and submitted to the ' ' g sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot pl~ showing location of lot and of build~gs on premises, relafions~p to adjo~ng premises or public streets or areas, and giv~g a ~etffied deswiption of layout of property must be drawn on the diagram which is pa~ of this appli- cation. c. The work covered by this application may not be commenced before issu~ce of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Bufld~g Pemit to the applicant. Such pemit sh~l be kept on the premises available for inspection throughout the work. e. No build~g shall be occupied or used in whole or in p~ for ~y purpose whatever until a Ce~ificate of Occup~cy shall have been granted by the guilding Inspector. APPLICATION IS HEREBY MADE to the Bulldog Dep~ment for the issu~ce of a B~lding Pemff pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, ~d other applicable Laws~ Ord~ces or Regulations, for the construction of b~ld~gs, additions or alterations, or for removal or demolition, as here~ described. The applicant agrees to comply with all app~cable laws, ordnances, bufld~g code, hous~g code, and reg~ations, and to admit authorized ~spectors on premises and ~ build~g for necessa~ ins~ctions. ~ . ...... . .... ; .... ; ............................. - (Signature of applicant, or na~, if a corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner ofpremises . ~. . t' [ [ t'.OdO. . .C... . ~.. .b. .~. . .O~.. . ., .~.~... . .~'. . ~].O.F.~{7[q~. . C.. ......... ................ (as on the tax roli or iatest deed) If applicant is a corporation, s~gnature of duly authorized officer. (Name and title of corporate officer) Builder's License No ........ /. ~. ............... Plumber's License No ....... ~Y~J)CC.tT. .......... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. .... ............. ! .................... ............... House Number Street Hamlet / Lot /?~ ~ /£' t County Tax Map .N,p~ 1000 Section ....... /. O../~. .....Block ....... {/"-)~7'o ........ Subdivision./~V~'~ ~:t.~b, Cwn..~/:~.~ .............. Filed Map No.. :~ ..... Lot . ~.;.;.. (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ......... t~..Oj~...E ...................................................... b. Intended use and occupancy ...... .~./}[~..~....~.Q/.~.,. [.~.... ~e///"'~' ............................ ~scripfion) 4. Estimated Cost .... 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 ..... ;...: .~.~.~; ........................................................... 6. If imsiness, commercial or mixe~ occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structure~, if any: Front ............... Rear .............. Depth ............... Height ............... Numlber of Stories ........................................................ Dimensions of same structure w{th alterations or additions: Front ................. Rear .................. Depth .................... ... Height .... ~.~, t ............... Number o,f Stories, 4 ........... , ......... 8. Dimensions of entire new construction: Front .~.'.d~..,~..':.. Rear .. ~r'tzr'77.. :~c...-'~,~'~epm . ~... 7.~. ~(~..~ Height ../.5. ':':. ....... Number of Stories ..... ] .................................................. · ~5- , , . ~ ,., / i 0" 9. S~ze of lot: Front ......... /.~. :.(9.. ...... Rear ...q.(a. :~.0. ............ De~,th . ..~...3.. ,7 ............. 10. Date of Purchase . ../.ff ?.5c...i ......... ' ......... Name of Former, Owner . . . }~.-.-.~.. {~ ........ 11. Zone or use district in which pr~mises are situated .... /~ .~*/d e~a~-P.ct~0 ....... ~'. ~.../. ii .................. 12. Does proposed construction violate any zoning law, ordinance or regulation...glO. 0 ........................... 13. Will lo~ be regraded .... ? .e. $.'..~., ............... Will exces~fill be removed ftr~.~m premises: Yes 14. Name of Owner of premises ./~...P'./1.~ l~.~ ........ Address .~.~.~..OJo g.rt~.~.[.6%o .[~.3Phone No. ,.~-.t¢..Z.(, 3'7 Name of Architect ....~ff.¢.~ t.',( [ ............... Address ................... Phone No ................ Name of Contractor . ~idq'~ a ~.~..~0~ ........ Address ................... Phone No. ? ~ ~. 7.-5 ~ 6,. ~a. PLOT DIAGRAM Locate clearly and distinctly all'buildings, ~hether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block ~umber or description according to deed, and show street names and indicate whether interior or corner lot. ~ ~ t~_~ ~9 ~v ~t~'~'~'o~ , ~ STATE OF NEW ;fORK, .............. · .~..~..... · ·.. · .............~' It>~'~'~ being duly sworn, deposes and says that he is the applicant , (Name ofindividuai signing contract) above named. He is the ................................................................................. (Contractor, 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 cont0ined in this application are true to the best of his knowledge and belief; and that the work will be performed in the manne~ set forth in the application filed therewith· Sworn to before me this Notary Public ...... .~. x .. County ' ' .c ~s.~' ~e. ,~ s~ ~,!~ c,,,,~t~ (Signature of applicant) TOWN OF $OUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 May 9, 1983 TEL. 765-1802 Mrs. Margaret C. Phelon 215 Northfield Road Hauppauge, N.Y. 11787 Re: B.P. #10418Z Dear Mrs. Phelon: We are returning your check in the amount of $55.10 which reflects the old fee under this permit number. Please advise if you plan to add the garage under this permit~ if not the fee calculated without the garage is $50.10 and $64.10 with the garage. There was a new few schedule put into effect on February 1, 1983, thus, the increase over the original. Yours truly, Edward F. Hindermann Building & Housing Inspector EFH:ec Enclosure I , F , [ ~ ~ /' : ' ~ p~ FOR THE -tlRctS-COh CRFTF % --- ' ust ' RESPONSIBLE FOR ; CONST~UCqoN , ERRORS.