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HomeMy WebLinkAbout9824-Z FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N, Y. BUILDING PERMIT \ (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ir? 9824 Z Date ......................... .V.L.\`................ 19 ••O Permission is hereby granted to: n L _ r M O ................................................................................ ................................................................................ .......... .CC.C... •• . i..................................................................... i to ...... � vl� 0TO6 C ... : . .... ................................................................................................................................................................ of premises located at W, 0• w 3-1 wo 0 D /- A N r ...................................................... ............ ................................................. Pkroylc ................................................................................................................................................................ ..... .......y... .......�,.� ©.......�...�......................................... .................................... pursuant to application dated .........................J V N� JG, 19�...., and approved by the Building Inspector. Fee $.... .�.............. ................................................................................ Building Inspector � D 1c,� nz cD��er FORM NO. Y � TOWN OF SOUTHOLD BUILDING DEPARTMENT /q TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined / .. Application No. 7 Approved ..... ..1.., 19Z� Permit No. ..... ................ Disapproveda/c ........................... .............:.......................................... n 0 ....................... ........................................................................ C (Building Inspector) APPLICATION FOR BUILDING PERMIT Date .............................:.�xoa z�, 19-.?.$....... 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 application.c 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 Occupancyr shall have been granted by the Building Inspector. C APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to theT 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 buildings for necessa ' spections. .... .. .. .............. . ignature of pp ant, or name, if a cor oration) ' ............. . .................................................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..........at P r...........................................y..........................,................................................................................................ Name of owner of premises .. CO ...I�.:.. .1Y[ZC?.C1.................................................................................................... If applicant is a corporate, signature of duly authorized officer. ..............................................:....... .............. .............. a y (Name and title of corporate officer) Builder's License No. ... Plumber's License No. ............-:............................... ���G Electrician's License No. Other Trade's License No. ............:................................ 1. Location of land on which proposed work will be done. 1�M,ap No.: ........................................ Lot No. ........................ C�.l.�Q► ....Q(Zi11 ... ... aY.1n..... Ck..�....................................��.QYI.t. ........ Street and Number ,,,,, � �C Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy .J QL nC.............................................`....................................................................... b. Intended use and occupancy ..`�.51.�.I. ..S ` ,C .... .!.` ...................................................................... . 3. Nature of work (check which applicable): Now 8uiidih�'`-B^ ........ Addition .................. Alteration ---'-.' Repair -.----- Removal ------ ben�b �ion�--�`--�-. Other Work ---------------- ~' ��' (Description) r oo ' 7��i�-~ � ' ` ` ` /L Estimated Cost '*^���"./14----_---.--�-'--- �^e -,-r-------_---_----__--___________ ' (tu be paid on filing this application) 5. If dwoUing, number of dwa kng units ....0.....................Number of dwelling units on each floor ...0...................... M IfQoroQu number -of cars --^'--.--------'------------------------------------- . 6. If business, commercial or nnhuud occupancy,' specify ' ' hd extent of each type of use ..0-------. 7. Dimensions ofexisting structures, if any: Front --..��---.--- Rear .............-------' Depth .....�.............. Height ........:.............. Number of Stores --.............................:............................................................................ Dimensions of some structure with alterations orodditions:, Front _-_--...................... Rear ..........-----' Depth ........... ------ Haight ........`_.................Number of Stories --.-'r-----. , ' ^ ^ ^ 8. Dimensions of entire new construction: Front -��'��-.,_----- Reor -.��.��---_- Daoth -.��.��---. c� ^/w * C���C� Height -_..,--.- Number of Stu�ma ...0 �� �� h� ��� ' � �� - 9. Size of lot: Front .,.--/^`x---------_---. Rear .^�.,^--._------- =---_--_ lO. Date of Purchase ---------Nomu of Former Owner Qk-)l.-��mya......... .................... �� 11. Zone or use district in which premises are situated 'e���/����)JJ��----_---.--.--_------------.. .^ �� 12. Does proposed construction violate any zoning low, ordinance or regulation: '^ C)................................................. 13. Will lot be regraded -..���l----.- Will excess fill be removed from premises: ( ) Yes (°l No �, �� `�� 14. Monnaof Owner ofpnanniswo���]��c.:-zx,-��/����|��-.-. ��d�eos ,��,-�&�.'���/���5��PhonmNp. ^ ' ^ Nonna of Architect --.�\a��\�. ...................................... Address ............. .................. .Phone No ...................... Monne of Contractor --. --'_--.--'-._.- Address .---....-.......-.. Phone No _.-.--.--- ' PLOT O|/\GR/\N\ Locate clearly and distinctly all buildings, whether existing or proposed,'and dicat. all 'k dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate 'whether interior orcorner lot. . � . ( . ��! � -------------being' duly sworn, deposes and-says that he is the applicant (Name of indivkduo| signing contract) above named. Heis the -----'' -'.------''.---'-'-''---''.--~-'---'------'.-'-'-'-.---------'. (Contractor, agent, corporate officer, etc.) -pf said owner o, 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 thar the work will be performed in the.manner set forth in the'application | therewith. Sworn to before me th is ELEVV Notaryruoxc, '`�=^r -~~~~`'vr~~^----^-~-----'?�-----------'------' -��IV 0igna uob of applicant) CD -., ssau co -� �� 2979 , ` Dc�ttC IA wA'.KWAIY /�---� v 14 C4 �— e �ze ' Ile