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HomeMy WebLinkAbout22337-zFORM NO.3 TOWN OF SOUTHOLD BUILDING DEPARTMENt' TOWN HALL SOUTHOLD, N.Y. N~ 22337 BUILDING PERMIT ITHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHOR/J~ED) · ?¢, ..... Z Date ....... ~ ........................ 19...~./ ........................................... ....................................... Countc Tax Map No. 1000 Section ....... ./.~/.,,~........ Block ...... ~ ............... Lot No..../..~ ........... pursuant to application dated ................ ...~,..~..~.... ~....'(~... ............ 19...... ,~...('~.. and approved byt.e Building Inspector. Fee $.....~'., ................. Rev. 6/30/80 Building Inspect/C/ Approved ..... c.~/~... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL,: 765-1802 BOAKD OF HEALTH ......... SETS OF PLANS .......... .~SURVEY ................... ~CllECK .......... Disapproved a/c .... . ................... .~ ......... ' //. (Building Inspector~ A P~ICATION FOR BUILDING PERMIT Date....~./?..0 .......... 19 INSTRUCTIONS 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- c,ation. 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 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 building for necessary inspections. - . (Signature of applir~fit, pr narge, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...... © T. .............................................................................. Name of owner of premises ...D~.;. [[.*.r cJ...~. J~J.D.T.{.h .~. ! .o.~...~.....~....~.. 0Q¢.~....]-.o.g... ' (as on the ta~ rolt or latest deed).c/ If applicant is a corporation, signature of duly authorized officer· (Name and title of corporate officer) Builder's License No ..... C)..LO ~ .~Y~. .......... Plumber's LicenseNo ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. · .......... ......... IIouse Number Street Hamlet County Tax Map No. 1000 Section .... ].J..~. ..........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 . ~ OD ~ . .............. b Intended use and occupancy ......................... ' ' .... C~ ~) y~ 'e~ . . '.",,.; ................................. 3. Nature of work (check which apPlicable): New Building .. Addition . .. Alteratiort Repatr .............. Removal .............. DemohQon .............. Other Work...~..~. ?..~; .e_: .... ¢(/zgF~C3 ~i ' ,~., ,, ~[~cription) 4 Estimated Cost F ' (to be paid on filing this application) 5. If dwelhng, number of dwelhng 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 structure~, if any: Front ............... Rear .............. Depth .............. Height ............... Number of Stories .......................................... · DimensigBs of same structure w alterations or additions: Front Rear Depth ............... eh' ' '" · Height ........ . ............... Number of Stories ......... ~). . .~ ...... S. Dimensions of entire new~ohs~fruction: Front .. ~ e/' ' ............... Rear .../.'r=.o.~. , . Depth .J¢ tt~, Height .~.~Vl¢'' ./°tt'¢¢.~. · Number' of Stories ......... . .................... -: ................ .... 9. Size of lot: Front .... /~( .. ! ........... Rear .... ..............' Depth ./Y0~J~...~..e.~]'... .&.o.o.,.~.6. ~s~ I0 Date of Purchase ~ ~ Name of Former Owner -- 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed con~truct!o~n viol~te any zoning law, ordinance or regulation: .~O ............................. 13. Will lot be regraded .... lY.O....: i ............... . ....Will excess fill be removed from premises: Yes 14. Name of Owner of premises ./.q: [~?.d.. fl. ~o .~.hv,J.~Address ~.of..r. /V~.co S.~.~.~. ti Phone No 5a-~4~ -¥?X/ . Name of Architect Noy! ~: i Address . . '-- ' . ......... .... ~ ' "l ................................ rnonemo ...... Name of Contractor .. 0.~..%. i · · Address ..... Phone No ........... 15. Is this property within 3[0'0 f'e'e't' 'o'f 'a 't'i~'al wetlah'd'?' ' *~e's '' '.'.'.'.. ~o.~. J.'.' '' · If yes, Southold Tiown Trustees Permit may be requir~] ~\ .... I 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 coruer lot. ' ,/24Z4~,M-.~_~ ~ NOTIFY BUILDING / ~<~¢- . 765-1802 9 AM TO 4 ~ FOR THE i /2 /]/.,~ ~ ~ ,, / ~ ~ FOLLOWING INSPECTIONS: (/ ' FORE(' ~ ALL COF,~S~'~'*LICTtOtB SHALl. MEET STATE CONSTRUCTION & ENERGY Cf)DES ¢101' RESPONSIBLE FOR DFSIGN OK 6~[B,~6~1~ E~ORS, STATE OF NEW YORK, Si S COUNTY OF .... ,~.4. J~.~¢ ...... ' .. _ ~., ~ 'ft~ .~/.. fi]. ZT/~'.~ .'~-/,~.~..~,, :r, . being duly sworn, deposes ~d says that he is the applicant (Name of individual signigg contract) above named. He is the ....................... ~ .................................................................. ~ (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly~authofized to perform or have perfomed the said work and to m~e ~d file this application; that ail statements contalfied ~ this application are true to the best of his ~owledge and belief; and that the work w~l be perfo~ed in the m~nar ~et forth h the application filed therewith. Sworn to before me this ..................... v .... '" ' ' ' ' ............ "" ~1~, g~l~.. (Signature of applicant ) FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 19 BOARD Of' HEALTH ~/3 SETS OF PLA,~ .......... /'SURVEY .CIIECK ........ Disapproved a/c ..... ..................... ~ ......... - A P~ICATION FOR BUILDING PERMIT INSTRUCTIONS 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- c,ation. 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 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, anff'regulations, and to admit authorized inspectors on premises and in building for necessary inspection~z_. - (Signature of applic~fit, pr nan~e, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises.· .f~.;. [(0.~. Cl....~... J~l.O.y.~ ~ .~ { p.[.~.%..~..~. ~OCt.~.. ~... (as on the tgX roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..... 0 .L~ B...~. ~. .......... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. · ..... : ............................ IK .......................... House Nmnber Street Hamlet County Tax Map No. 1000 Section .... /./..~. .......... Block ....~. ............. Lot .... /...L~. .......... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of pre_,nises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....... q ~ ..................................................... b. Intended use and occupancy ................................. · 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair Remolval Demolition Other Work f-~ m~, , · I ' ' (Description) 4. Estimated Cost ~..~)d') -""- ..... ~. .... I .................. 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 ..... ! .................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type 'of use 7. Dimensions of existing structure~,ifany: Front ............... Rear .............. Depth .............. Height ............... Numlper of Stories ....................................................... Dimensions of same structure with alterations or a. dditions: Front ........ ' ......... Rear ................. Depth ...' ............ i. Height . D' ' . ~- eeoc_ ....... . ............... Number of Stories ........... ..~ ......../. 8. ~mens~ons of entire new construction: Front ..... ' Rear .. ./[?-~f',' .. . . . . Depth ./.'7/v.. ..... ta /2, O.... ~. Height .~.~./.e. .4' ¢.e¢, ~. . Number of Stories 9. Size of lot: Front .... /0~..( .. ~ .......... Rear .... /?..3.: ............. Depth 10. Date of Purchase . .'Y.. " N ·, ......... amc of Former Owner . 77. .......................... 11; Zone or use district in which premises are ~ituated ~ ~ ...... 12. D.o. es proposed construct~qn wol~te any zoning law, ordinance or regulation: . ~P ........................... 13. Will lot be regraded ... ~t.o..... i ........... Will ex~ess fill be remo~v.ed from premises· Yes ~ ~, · ., ............... .a ........................... rnonemo. / Name of Architect . t'~0~ ~Address . '. ~'~ .'~-'). ?.~' Add Name of Contractor.. ~ ........... . ....... ress .................. .PhoneNo ............. . . . 1.5. Is this property withln 300 feet of a tidal wetland? *Yes ........ No./~. ...... · If yes, Southold Town Trustees Permit may be required. ,, PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions fronl, property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. NOTI~ BUILDING OEPA~ FOLLOWING INSPECTIONS: 1. TwO ,q HA LL MEET ENERGY R~SPONSIBL~ FOR gTATE OF NEW YORK. ?OUN-rY OF .... .-.~o...~ ...... . ... ~...//'/'/~ .~'Z. ~]. gq,/,., .~.~t e., ?..~.'.-~'.'.' ............ being duly sworn, deposes and says that he is the applicant (Name of individual signin contract) ~bove named. le is the ....................... ?..?..~.. ......................................................... (Contractor, agent, corporate officer, etc.) )f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this pplicafion; that all statements contai~ ed in this application are true to the best of his knowledge and belief; and that the ~'ork will be performed in the manner ~et forth in the application filed therewith. ,worn to before me this .................... ...... It01tERT [ ~ '~ ..... NOI~RY pULt~'"~ '~'''~-'- (S~gnature of apphcant) ~ ,,,~,.~Lu, ..m.:te of N.Y. Teml Expires Malt 31, 19 '08 '~,, 8£ ~ ,.". · ,.,. AVENUE