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HomeMy WebLinkAbout13284-z F6u~ HO. B TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PER/vtIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 13284 Z Permission is hereby granted to: ...l.~.~..../.~..~....~ ......................... ~o..~~ .......... ~. ....................... ~ ............... .C. ............ ~.~~. ............. ............. ; ....... ~ .......................................... L'"'"'/~ ............ ~ ..................... :,' ...................... ot pram,sas located at ....j..c]..~ .......... ~..~. ............. ~..?...~...~ ............. County Tax Mop No. 1000 Section ..... ..t~....."~...?. ...... Block ......... )...O.. ....... Lot No...;...~...~. ............. pursuant ,o application dated ....... ...~...~./. ......................... , 19.~..~., and approved by the Building Inspector. Rev. 6/30/80 3. Nature of work (check which applicable): New Building ..... ' ..... Addition .... Alteration .. '~a Repair .............. Removal .............. Demolition .............. Other Work..~.~?.c~' .... ' ' 4. Estimated Cost...~....~.~.0..0. ........................... Fee ................ ...................... (to be paid on filing th~s application) 5. If dwelling, number of dwelling units ....... ./ ....... 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 ............... Rear .............. Depth ............... Height ........ /. ...... Number of Stories ........ ./. .............................................. Dimensions of same structure with alterations or additions: Front ...... .~Y./.~. ....... Rear .................. Depth ...................... Height ................. . ........Number of Stories ...................... -8. Dimensions of entire new construction: Front . ./.~q ~(~s.~ .~.a.~ .~. ] Rear ....~./ff. ........ Depth ............... . Height ....~w. ........ Number of Stories ..... .~,/.~ ................................................ 9. Size of lot: Front ...... /..o.~. ............ Rear ..... ./.~.~ ............ Deoth . .9-.~..7-/..2.7~.... 10. Date of Purchase .../?~..2..~.?~ ................ Sam~of,Former Owner .~.~.' .~...e'.~.~. ~ ........ 1 1. Zone or use district in which premises are situated ~.d-Lz..~*.~. ~. 9.4-.~.o~. ................ f.. ............... 12. Does proposed construction violate any zoning law, ordinance or regulation: .... .~...o ......................... 13. Will lot be regraded ...... .,~..o. ..... .; ............ Will excess fill he remove_d from premises: Yes NoX 14. Name of Owner of premises . ~. ?. ~..~'.~.. . Address/.~.o .~.t/./.~.~.~..A..~. .... Phone No..~..~ .g.% Name of Ar~hit~* '~'~'~'~- ~.,~ .... ~,~,"de,~ e',_c. ,~,/ ,,~ ,, "' Name 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 NEW YORK, COUNTY OF ................. ................................................. being duly sworn, deposes and says that he is the applicant (Name of individual 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 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. Sworn to before me this ............. ~./. ,~. ..... day of... .... ~...~.~....~..~.. · .~..~. · .... County ·...........~10'f~R¥ ~BllC, State No. 4707878, 8u(lotk le,ii [~,0s Uateh 811, 10~,~_~ ' c(Signature of applicant) Approved .]. G ..... 19~ ~!. 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Disapproved a/c ...................................... (Building Inspector) APPLICATION FOR BUILDING PERNIlT INSTRUCTIONS Received...~.'/.~ a. This application must be completely filled in by typewriter or in ink and submitted 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 appiication may not be commenced before issuance of Building Parmit. d. Upon approval of this application the Building Inspector will issued 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 Reguiations, for the construction ofi buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building c3~te, hou~sing code, and regulations, and to admit'authorized inspectors on premiies and in building for necessary inspe,~j~ ' ,i (Signatureof ~ph'ca~t, ~)r nah:v(, if a corporation) , : i (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .... ............. i .................................................................... Name of owner of premises....~.~. '~'t'H...~. i'.. ?....~.¢.~.~...'~..' ....................... (as 6n the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) No ' Builder's License ........ ! .............. : Plmnber's License No. Electrician's License No ..... i. ~/?. ............. Oth r Tr de's Lice N e a nsc 0 .................... 1. Location of land on which proposed work will be done .................................................. House Number : Street Hamlet County Tax Map No. 1000 Section O .~ Block Lot. Subdivision ................ ~ ................ Filed Map No ............... Lot ............... 2. State existing use and occupanc2 of premises and intended use and occupancy of proposed construction: ' a. Existing use and occupancy .i ......... [ .~..~ [[ ..................... b. Intended use and occupancy ...... ~..~.c..~. ?....~...~.... --"- ................