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HomeMy WebLinkAbout10826-zN©. eUILDING DEPARTM£~i TOWN HALL SOUTHOLD, N~ Y. BUILDIHG PER/~IT~ 'i (TH S PERM T MUST BE KEPT ON THE PREMISES COMPLETION OF THE WORK AUTHORIZED) 0 8 2 6 Z Date Permission is hereby granted to: ........ ..... da,~..o....~,~./,~ ......... UNTIL ULL County Tax Map No. 1000 Section .,.~.~./ ....... ;. Block . .~ ........ Lot No. C~:..7 ........... pursuant to application;dated .~.~ ........ ~ ............. ~.,.{i-.,.., 1~, and approved by the ? ~ Buil~n0 Inspector. lee *../...~..~ ..... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765~1803 Approve~.4/~. ..... /4/ ....... , 19 .~.~ Permit No./~.d?;.~. 4 ~ Disapproved a/c ..... .~.... :.'~. ......... ..~ ........... / ................. :. ......... APPLICATION FOR BUILDING PERMIT Application No .......... 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 th~s application may not be commenced before issuance of Building Permit. d. Upon approval of th~s 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, hgu~ing code, and regulations, and to admit auth°rized inspect°rs °n premises and in buildings f°rnecessary~sp~cti°.~ (~_)~?(~ff.~,[2~,,~) --~-~?e~, ', if or or lo (tSigf~gt-u~e of {tpplicant,;pr nan3~, ' a ~ p~ :gt' ,p) ~ (Mailing address of applicant) I [ 4'7 [ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....... .......................................................... ............... Name of owner of premise~..~(~ .~..t)[.. (~, ~ ! .~(J.~..~.: .................................................... (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 ..... ~.~ (-* ..~. ........... Plumber's License No ......................... Electrician's License No ...................... Other Trade's License No .................... 1.~0 ~ ~-[~L°cati°n of lanC4cn~)~)F(~.,V[,0N)whlch proposeqt>igj~.0 t)~ )w°rk will beton e ~ ~ :/ ................................................. .~C~:[/i.?l.]~.d.~..~/ House Number Street Hamlet County Tax Map No 1000 Section . ..~.'~] ........... Block 0 z~ Lot OOr~ Subdivision .................................... 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 ...~)~9 b. Intended use and occupancy . . 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Worl~.O~.:~/.~..~..~.'.~.A/..~'.~ ~ 15-'O ' ~/ (Description) 4. Estimated Cost .................................... Fee ... 1 .~. ................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units .... I ........... Number of 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 ~e . Rear Der)th DH;imgehntsi~n~of s~a~te structurN;w~'tbt~ra;:rSatt~;~ne: or a~ddditions: Front. ~-~ ~. ......... Rear .................. Depth ..................... ,. Height ...................... Number of Stories ...... 8. Dimensions of entire new construction: Front..5 ............ Rear .............. Height ............... Number of Stories .................... 10. Date of Purchase . .~.. Pr~..[2 ~d~. ~[ ....... ~,q?. ~ .... Name of Former O~ne,r, ............................. I I. Zone or use district in which premises are situated .... t..F/~c/P/! .L.~I... ,c~k.~ .l~d. ¢.14.q ¢ ............... 12. Does proposed construct~ign violate any zoning law, ordinance or regulation ~.'0 ....... 13. Will lot 'be regraded ...t'~.O..., ...... . ............. Will e.xcess fill De remov_ed from premises: .-,. Yes (No} 14. Name of Owner of prem~s~t~J ..... '~-~Z..~. .... Address0Ol .6-0.,~/~. ,' .... .~. ~. Phone No ........ q5 ..... Name of Architect .......... ; ................ Address ................... Phone No ................ Name of Contractor ......................... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all ibuildings, 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. ikoc L No- Lo'Z' N o o o '7 STATE OF NE~ Y~RK, . ~ , ~ COUNTY OF .V. ?.O. h .K. .... .......... · c~.O..~r?f..... ~ .... .~. [ ~ .~..~. ~ .......... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. Heis the.. ~ . .(~. · .~.~.~.. '.-...~.~r. ,¢~...~./7. ............................................................... (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 contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. ........................ day o~ 3.LX ................. ' , §2.0344963 suffol? Oou ~ (x~) (Signature of applicant)