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HomeMy WebLinkAbout13937-z l~OR~e NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 13937 Z ,o .~~........~ ...... ~....~...~.~.~,.~ ....... ~......~.......~..... .................... at premises located at .. ..~ .........~ ................ County Tax Mop No. 1000 Section ..... .,~..,..Lg...,~ ...... Block ....... .~....~,,. ..... Lot No. ,...~....~. .............. application dated ........ ..~....~...O~. ......................... , 19.~..~.~ and approved by the pursuant to Building Inspector. Building Inspector Rev. 6/30/80 Page No. of Pages 't 745-1P?° ~ AM TO 4 PM FOR L ,'F(.TIONS ). FOUN:',,' -,'hN _ TWO RFOUIRED Fn~ ':'l'?l 1~ CONCRETE 2.ROLR~ ~RAMtNG & PMJMBING L FIF'~' r"~"'S': .... ', IGN MUST U_L Cr~Nq:r""':!ON SItALL 'lie RFO~' '~:,x~SNTS OF THE N,Y. ;TATF CONqTRLICTION & ENFRGY ]ONES. NnT RESPONSIP!E FOR )ESIGN OR CONSTRUCTION ERRORS. ~ of 'FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~*OUTHOLD, N.Y. 11971 TEL.: 765-1803 ~xamined ................ ,19 ... kpproved ................. 19... Permit No../.~..~.~. ~?. Received ........... ,19... )isapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Tins application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 '4s 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 r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- ~tion. 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 issued a Building Permit to the applicant. Such permit aall 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 hall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Btfilding Permit pursuant to the ,uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or [egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. 'he applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to mit authorized inspectors on premises and in building for necessary inspections. %.,~ ~.,.;..~ .~.~,~_..~.,~'~ .......... (Signatul'~of applicant, or Mme, if a corporation) P..o. lB. ~.~. ~r~. ~c...~ o'.,~,-~ ~. ~ d .~.7. ~ i .~.~. (Mailing address of applicant) :ate whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. .G.~.~ 1...~..~ ,~ .-r'.~ .~_s'.o...~. .............................................................. Iame of owner of premises ~ .~. ~.~o,.r~ eat':.. ~. ~....(~.. r~ l .~ ~ ~-, ~ rr> ............................... (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 ................ ;.~-. · · Locati6n of land on which proposed work will be done .................................................. ..............~..o. ~ .~ .~.-~, .~..a ~ ~ ........ S..,,.-~.' 1,. ~,.I.~/, ................ House Number Street Hamlet County Tax Map No. 1000 Section ...4 ff-~ .......... Block ... ~ ............ Lot....~...~ ........... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . ..~.. ~?.e~..~..}. O.'t-T. ................................................... b. Intended use and occupancy .~.. .......... CJ' ~,'~a'~"'~" ' ~ .... ? ............. 3. Nt/ture of;flko~hich:,a plicable): New Building ..... '; ....'Addition .......... AlteraJlon .......... (Description) 4. Estimated Cost ............................. Fee ...... '. ~ ........................ ~' (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ If garage, number of cars .... i .................................................................... 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 i Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ...................... Height ...................... Number of Stories ...................... Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Sto~es ........................................................ Size qf lot: Front .......... ~ ............ Rear ...... ' ................ Depth ...................... 10. Dare'of Purchase .......... i ................... Name of Former Owner ............................. 1 1. Zone or use district in which premises are situated ..................................................... 12. Doespropos. e. d construction vi61ate any zoning law, ordinance or regulation: ...}9.q~ .......................... 13. Will lot be regraded ........ : .................... Will excess fill be re/noved from premises: Yes No 14. Name of Owner, of premises . .:. (,-~. ~.,[ [x~ ~ .... AddressCl 8 ~.. [~Soc,,.rko),d,,*x~c.,~u%Phoneu No..~./~:~.': ~7~ .~ .6.~. Nam~ of Architect >; ...... , .,.: ................ Address ................. (}.X~?hone 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 bloc~ number or description according to deed, and show street names and indicate whether interior or corner lot. i ' STATE OF NEW YORK, COUNTY OF. S.S ............................ . ..................... being duly sworn, deposes and says that he is the applicant (Name of individual s~g~ing 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 apphcat~on; that all statements contained m th~s apphcation 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 Notary Public,. ~.~-~....~.: .i./~. ,/'f. ......... County 1~, ~,~'~.~ (Signatur~ of appli~a, nt) "FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1802 ',xamined .... ~..{~. I 0.., 19 .~.~. tpproved ..~"~' '};..,19!.~.PermitNo..}.~.~..~.~..~. isapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT BLDG. DEF'r TOWN OF St')L!TI'~O!~. .... Received ........... ,19... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ts 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 areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- tion. 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 issued a Building Permit to the applicant. Such permit all 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 all 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 tilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or ~gulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. te applicant agrees to comply with all applicable laws ordinances building code housing code, and regulations, and to mit authorized inspectors on premises and in building for necessary inspections. .............. (Signature of applicant, oF'name, if a corporation) (Mailing address of applicant) :ate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ane of owner of premises . .~,~o .,..~. ~.,...~..~ ............................. (as on the tax roll or latest deed applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Build'er's License No .... ~. ?.~0. ................ Plumber's License No ......................... Electrician's License No ....................... Other ~rade's License No ...................... Location of land on which proposed work will be done...~.~.~... ~ ~-~v'~..~na,4~. ~ ........... ........................................... ........................ House 1;i Number Street County Tax Map No. 1000 Section ..... ~.~. ......... Block ....... .~. ......... Lot... ~..7 ............ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....(~. ~ q~,...~,c:.~.c~.. ~ c-.o. ~2.~ .~..K O .~ ~.e~.~ .......................... b. Intended use and occupancy ...~..~.~10. ~.*-~ .c~.e. ~c~. O~r.~o.~ .~..~Otxt2 $.,~ .qo.~.~.~. ~I.~.W..~oO~- 3. Nature of work (chec,k~which Repair ..... ~.~...v~.~ Ren 4. Estimated Cost ..... 5. If dwelling, number of dwellin ~plicable): New Building .......... Addition .......... Alteration .......... 0val .............. Demolition .............. Other Work ~'T (Description) (to be paid on filing this application) ~nits ............... Number of dwelling units on each floor ................ If garage, number of cars ...................................................................... 6. If business, commercial or mi~ ~d occupancy, specify natt~e and extent of each type of use ..................... '7. Dimensions of existing structure's, if any: Front ........ ' ....... Rear .............. Depth .............. Height ............... Number of Stories.. ............................................ -- i ........ Dimensions of same structure ~ith alterations or additions: Front ................. Rear .................. ~ Height Number of Stories Depth ................................................................. 8. Dimensions of entire new eom truction: Front ......... Rear .............. Depth ............... N robe of St ' ' ...... Height ............ r r ones ........................................................ 9. Size of lot: Front .... ~ ' ........... Rear ...................... Depth ...................... 10 [)ate of Purchase ' ~ Name of Former Owner 11. Zone or use district in which [ romises are situated ..................................................... 12. Does proposed construction vi ~!ate any zoning law, ordinance or regulation: .'~o ............................ 13. Will lot be regraded ........ : ................... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises . .i ................. Address ................... PhoneNo ................ Name Of Architect ......... i ................. Address ................... Phone No ................ Name of Contractor ........................ Address ................... Phone No ................ PLOT DIAGRAM tlI buildings, whether existing or proposed, and. indicate all set-back dimensions from c,number or description according to deed, and show street names and indicate whether Locate clearly and distinctly ~ property hnes, Give street and bloc interior or corner lot. I%c-r STATE OF NEW YORK, ~i S.S COUNTY OF ................. .......................... i t;~ ~ ................... being duly sworn, deposes and says that he is the applicant ~'(Name of individual s ~ i g contract) above named. He is the .................... i. i~ ................................................................... I ~ ' (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dglY authorized to perform or have performed the said work and to make and file this application; that all statements co~thined in this application are true to the best of his knowledge and belief; and that the work will be performed in the manfler set forth in the application flied therewith Sworn to before me this ~ ~IQI.~RY F'uCt.~c. State al ~ew York (Signature of applicant)