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HomeMy WebLinkAbout10228-z I~ORM 1~O. 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? 10228 Z Permission is hereby granted to: .....~..-..~.~ ~ ~z.....~..:~._ _ ~ ~. ..... ..... ~/~,~.:-z_~,~...z;;.-~._ ................... .¢~~.~z~~: ............. : ....... ~ ...................................... at premises locked ~t ~.,,(~'./.~....fT,,~...~.f~ .~..~...... ......... , ............. pursuant to application doted .......... ..~...~.~.C~...../..~ ............... , 19.~..~..:, and ap,~toved by the Building Inspector. 43u'dding Inspector , TOWN OF SOUTItOLD OFFICE OF BUILDING INSPECTOR TOWN MALL SOUTHOLD, N. Y. 11971 TEL. 765~1802 October 10, 1980 Michael F. Zukas Bayberry Road Southold, New York Dear Sir: This is to notify you that Building ~prmit 10228Z issued ..... M~y 18, 1979 to May & Mlchael N~u~as will expire on November 18~ ~198o If more time is required to complete the Job and obtain a Certificate of Occupancy, you may apply, ~y letter, for a six (6) month extension. If the work is not completed and the Certificate not issued after the six (6) month extension period, than required to apply for a new ulldlmg permit. Very truly yours, Sr. Building Inspector of Occupanby you are GHF/mw FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined...~.T .-. '.~./. ...... , 197~. // Application No../.~.~..~...~.. ....... ...... ...... , ............... ........ , · . .. (Building Inspector) 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 of property must be drawn on the diagram which is part of this appli- cation. 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 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 necessary inspections. (Signature of applicant~r/flam~f ~c~,poration) ' ~] [~vlailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (as on the tax roll or latest deed) ~ / If applicant is a corporation, signature of-'duly authorized officer. (Name and title of corporate officer) Builder's License No .... ,,~J~.. .............. Plumber s License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1 1. Lotcation of land on which proposed work, will be done...~~ .4~.~..? .~.~. House Number Street County Tax Map No. 1000 Section .... (~).7.~. ....... Block ...~./. ........... Lot...~../. ~.T ......... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occj~pancy of proposed construction: / / a. Existing use and occupancy ...... ~O_~~ ..... ../.. b. Intended use and occupancy .... .~(l~. ~.. ~/~ . ~'~ ~'~//~ 17~ .......................... 3. Nature ofwork (check which applicable): New Building .......... Addition .......... Alteration .......... Repmr .............. Removal ............... Demohtmn ....... : ....... Other Vl/ork ............... 4. Est~ated Cost ................................ ,. .... Fee .... ~ ........................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number o f 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 Stohes ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ...................... Height ...................... Number of Sto~es ...................... 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 ............................. 1 1. Zone or use district in which premises are situated .................................................. 12. Does proposed construction violate any ~qning law, ordinance or regulation: ................................ 13. Will lot be regraded .......... ~ ......~ ......... Will excess fill be removed from premises ~ ~es No 14. Nme of Owner of premises .. ~ ............ ..... Address ... l ...... [ ........ Phone No ................ Name of Architect ........................... Address ................... Phone No ................ Nme of Contractor .......................... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back 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 N .. couu f~vid~gning contract) above named. is th He e ........ :'. ........................ ...................... (Contractor, agent, coiporate officer, etc.) of said owner or owne~, ~d is duly authorized to perform or have perfo~ed the said work and to m~e ~d file this ' application; that all. statements contained ~ this application are true to the best of his knowledge and belief; and that the work will be perfo~ed in the m~ner set forth in the application filed therewith. Sworn to before mp ~is ......... .... .......