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HomeMy WebLinkAbout10698-z FORM NO. 2 TOWN OF SOUTH OLD 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? 10698 Z Date ....Jv"v,C.......z........................, 19d?O Permission is hereby granted to: 1.. ,~, ...f1.z:01..<.C7E.... .,...-J.C/.-Itu.<'!1.,t.; ,~. ...Js."o.~,..-#...q....C;....... ..... ., ..", , (/ ~ ...... "'.r.Cf.l.'Q7UC;..::7:':'..~. ,.. .., to ..,C().Iv.5T~~.CC....t..'!:.o..~......'!r.It?H ..,.. ,Q.r:..kA.o.ttZ....EZ:..<U.~..,.... ~:.~;~~;~~~.;~;~.:~~..~:.:;?:3;::::::yZ;~;;;J::::;;;;;::::J..:::::z.~;;;.;;;,:~~::::M7 . ;;;;;-;~:;.~:;..:i:;;~;;~:..:....::..:J~;~.7.:,::,?:::::::'il.iii,.(i::::::::::::Z:i.::::5..;;":::':: pursuant to application dated .....&I6J';f...."?,.')....., ....,.., 1.JQ.., and approved by the Building Inspector. F $ I"c-_~ ee .. ..-'.............. /' , 1; FIELD INSPECTION ~ DATE C OJ.VJMJ:<:N '1'::; - - . . 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"" ~,> ~.-7~ -",::,</, 0.-_, ;; > ~,'. ';' ,.......-.or ',~., '.,O,j<1_ .;- ''Y ;;,),-,>.;',:Z " _"OU ,>-' l ~"',,' '0'.,.., '. ',~ '" '\ ~ 7 _ l'- n c :J ~ ~ B ...: .... 7> 2 - t~ - .,\, >0>," "~', '\ '\ ~ ~ G Z -i r, r" g';; ~ :j > ~, ",,,,} , , ' "~' '/,' ',} 1 <A .Tj...-.....:!> ():L"':I<1 ?> .~ .... 0 - tt1 >, ' ,--,,', ~'<" , IJ ~ ~'j a ...: ." c: c: '" Z 7: ,-' , '~', .-, ..-'i/' .\1: .f1 , ~~ ?;~;ZO(;} >~I'"e, ..~~,~,'~'j~,;~,,~>-...\~;,t' _.______-_~_ ~-__;_~,.......---------:.o-~---.-.---....'-~---o,.~~........,..----~*....~ ' ..,j . . , ,>""'" 1, - r...,. "\" X~, ',,",.,'(J ,'\":,L'",:J'I:,l,o;;,;Ci;jfl-\r:..;"d<.,,;f'."'['~_\,::~:~,~<o,;.;,'_..^~....:'~~_~:.'j!~,-,~t~_;"',J.";' " ",- ...;. fORM NO.1 TOWN OF SOUTHOLD BUilDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 ....-- TEL.: 765-1802 ..., Examined J{/tY'~ . h. . . . ., 19@ Application No. ./a{'1f'.-f:...... APprove~Nt;. Y.. . . . ., 1Jb. Permit No. /cJ.tf tf. :2 - Disapproved a/c. . . . , . . . . . . . . . . . . , . . . . , . . . ......... . ....................~......,..,... .. .. APPLICATION FOR BUILDING PERMIT Date \"C)J-\ ,~. . . . . , . . ., 19~. 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. APPLICA TJON 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, ar 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. . . '~;;~~~~J;~'e', ii ~ ~~~~~;ati~~)' . . . ..... ~."'f.. ~ .~.~.... ~\~"':\.,~.~ .\'.~.... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. O~. ..... ......... ... . ,>............... ............................ ,........,..................... Name of owner of premises . ~~. .\:\ . .~~ .~~ }~~~. . ... . . . . . . . . . . . , . , , . . . . . . . . . . . . (as on the tax roll or la est deed) If applicant IS a corporation, signature of duly authorized officer. ..... ............ ,.....-...................... (Name and title of corporate officer) Builder's License No. '.pY".'.'....... Plumber's License No. .........,.............. Electrician's License No. ........ . . . . . . . . . . . . . Other Trade's License No. ..................... I. Location ofJand on which proposed work will be done. %~. ';;""~ \\.~. ~, .'. . . . . . . . . . . . . . . . . . . . . . . , ,. .z.?~~-........,.. . . \-\ J,.~ .~. . .. ... , . . , . .. . .. ~~h~,.\.vx, \\C\.::f~. . , . . , . . . . , , . " House Number Street Hamlet County Tax Map No. 1000 Section \:--~.-.~,.......... Block..~... . . . . . . . . . .. Lot.:::?............... Subdivision. .l<h\~. .\,,~~. QQ.G;\.<>.......... Filed Map No. ~~\Q..,...... Lot ..;;,~........... (Name) 2. State existing use and occupancy of premises and in tended use and occupancy of proposed construction: E'f d ~O,.o.....,u a. XIS mg use an occupancy ........................./'.... ~. . . . . . . . . . ~ . . . . . . . . . . . . . . . b. In'~d'" "~ Md '~"PM" ..... (? """- . c:x.I. .6. ~.O . . Va Q(4. de. . hr. . . .. . .. , i .) _A< ~\ t ~ t ".> it '; " 'i t \, , i.... .( . -, 3. Nature of work (check whicp applicable): New Building. . . . . . . . . . Addition. . . . . . . . .. A1tera~on .......... Repair .............. Removal . . . . . , . . . . . . .. Demolition .............. Other Work. )t,.. ~ . , . . . . . . . ~ (Descriptian) 4. Estimated Cost. . . . ~.~~Q.!.'. . . . . . . . . . . . . . . . . . . . . . . . Fee .I:;;;~. . . . . . . . . . . . . . . . . . . . . . . . . . . . . , (to be paid on filing this application) 5. If dwelling, number of dwelling units. . . . .~. . . . . .. Number of dwelling units on eaeh floor. . . . . . . . . . . . . . . . If garage, number of cars .....:........),.......................................................... 6. If business, commercial or mixe<;l oecupancy, specify nature and extent of each type of use . . . . ~ . . . . . . . . . . . . . . . . 7. Dimensions of existing structures, 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 const~ction: F~ont . . . . . . . . . . . . . .. Rear . . . . . . . . . . . . . . . Depth ............... Height ............... Number of Stories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \ . . . . . . . . . . . . . . . . . 9. . \!:2 \' \'::;y:J' \so SIze of lot: Front ., . . ~. .Q............ Rear...................... De~.... ~ . . . . . . . . . . . . . . . . 10. Date of Purchase .. .'.~ .~\~~.. . . .. . .. .. . . . . .. Name p/Formertt:ner '?\~;t:Z; \\!l;~.:.. ., . .. ... . 11. Zone or use district in which premises are situated. . . . . . . . . . A .'..( F;:;>( ~I(. . .4. . . . . . . . . . . . . . . . . . 12. Does proposed construction violate any zoning law, ordinance or regulation: ... R.......................... 13. Will lot be regraded ................. ~'K . . . Will exce~ be removei from premises: Yes No 14. Name of Owner of premises ~\,~ .....~. Address :~.. .. .~.-. .~. .... Phone No.'">>.~...$.\~~..... Name of Architect .. . . . . . . . . . . . . . . . . . . . . . . . . . Address ... . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . . I Name of Contractor . . . . . . . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. ., . . . . . . . . . . . . . PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-baek dimensions from property lines. Give street and block!number or description according to deed, and show street names and indieate whether interior or corner lot. o..u. ~ I I ..... .. ./,. '~9.. . .. being duly sworn, deposes and says that he is the applicant (Name 0 ndivIdual signing contract) above named. I He is the .........,..........~......................................................... (Contractor, agent, corporate officer, etc.) of said o~ner or owners, and is d~ly authorized to perform or have performed the said wark and to make and file this application; that all statements con~ained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manIjer set forth in the application filed therewith. Sworn to before me this . . .. ... ... .. ~.day of.. . . ... .. /YJa:f'" 19'i.'<Q Nota.!(fublic, , ounty ( " i . . .~. \-. ~~'1' (si~~t~~e' ~i ~~~li~~t) , ! i "1U':''i# ELIZABEtH ANN N VlllE NOTARY PUB\IC,Slate of New York N,I, S2~8125850! Suffolk County}IIB-