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Home My WebLink About10273-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) jUN;� C a .� �� No• 10273 Z Date ......................................................... 19........ Permission is hereby granted to: /(- -1 C�......... .1 . ............. .I I.....`...I..LL .JN.�... )........................ �c U 0 r ) .'�' l ........................................................................I....... to ....... ............. ............................................................................................... ................................................................................................................................................................ at premises located at '......,,,,�..0 I`! i� f!: !tii A V S tii. 17 1 Ir C f.).................. ..'..'- ......................... .1. .............................. ................................................................................ ................................................................................ ................................................................................................................................................................. �U�L .. 19 Jf// and approved b the pursuant to application dated ................................ ...................... ..l....., PP Y Building Inspector. rj c Fee $........................ ................................................................................ Building Inspector FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 _ TEL.: 765-1802 Examined . . . .. . . . . . ., 19 . Application No. . . . . . . . . . . . . . . . Approved . .'^':`. . .a 5., 19 . . . Permit No. . . . . . . . . . Disapproved c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Building Inspector) APPLICATION FOR BUILDING PERMIT Date . . . . . . . . . . �, ��, 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. 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 buildings for necessary inspections. . . . . . . . . . ... . . . . . . . . . . . . Jgnaiur�oia name, if a corporation) (Mailing'address of apphcart) State whether applicant is owner, lessee, agent; architect, engineer, general contractor, electrician, plu- ber or builder. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., . . . . . . . . . . . . . Name of owner of premises . . R ��!��'. . . :. f�r �/l.k�.l.�l. . . . . . . . . . . . . . . . . . . . . . . . . . :_.. . . . . . . . . . . . (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. . . . . . . . dW . . . . . . . . Plumber's License No. . . . . . . . . . . . . . . . . . . . . . . . . Electrician's License No. . . . . . . . . . . . . .. . . . . . . . . . Other Trade's License No. . . . . . . . . . . . . . . . . . . . . . 1. Location of land on which proposed work will be done. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . UP . . . Sot. . .A\,e .'� . . . . . . . . . . . . . .4 . . . . . . . . . . . . . . . . . . . . . . . . House Number Street Hamlet County Tax Map No. 1000 Section . . . . . . . . . .`. . . . . . . Block . . . . . . . . . . . . . . . . Lot . . . . . . . .. . . . . . . . . . . Subdivision . . . . . . . . . . . . . . . . .(Name) . . . . Filed Map No. . . . . . . . . . . . . . . Lot . . . . . . . . . . . . . . . 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . . 4!A4?l� . .1 32 . . c�-, am. b. Intended use and occupancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . y • ;ram 3. Nature of work (check which applicable): New Building . . . . . . . . . . Addition . . . . . . . . . . Alteration. . Repair Removal . . . . . . . . . . . . . Demolition . . . . . . . . . . . . . . Other Work . >` (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 . . . . . . . . . . . . . . . . Ifgarage,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 ofStones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dimensions of same structure with alterations or additions: Front . . . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . . . . Depth . . . . . . .. . . . . . . . . . . . . . . . Height . . . . . . . . . . . . ... . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . . . . . . 8. Dimensions of entire new construction: Front . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . Height . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. Size of lot: Front . . . . . . . . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . . . . . . . . 10. Date of Purchase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of Former Owner . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . 11. Zone or use district in which premises are situated . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. Does proposed construction violate any zoning law, ordinance or regulation: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13. Will lot be regraded . . . . . . . . . . . . . . . . . . . . . . . . . . . . Will excess fill be removed from premises: Yes No 14. Name of Owner of premises . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . .Phone No. . . . . . . . . . . . . . . . Name of Architect . . . . . . . . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . 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. I . 22 � it t c .1 STATE OF NEW YORK, COUNTY OP , . . . . . S.S `` . f 1... . . . . . . . . . . . . . . . . . . . . . . . . . . . .being duly sworn, deposes and says.that he is the applicant (Name;of individual signing contract) above named. lie is the . . . . . . . F:'. . . . . . . . . . . (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. . .`. . . . . . . . . .. 19 Notay Public. . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . County ` - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . (Signature of applicant) 3. Nature of work(check which applicable): New Building . . . . . Addition . . . . . . . . . . Alteratio Removal . . ... . . ; . . . . . . . Demolition . . . . . . . . . . . . . . Other Work Repair . . . . . . . . Oyo (Description) X..' * * — ��61 4. Estimated Cost ./. .��. . . . . . . .0�. . . . . Fee/L . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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 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 construction: Front . . . ... . . . . . . . . . . Rear . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . Height . . . . . . . . . . . . . . . Number of Stones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . 9. Size of lot: Front . . . . . . . . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . . . . . . . . 10. Date of Purchase . . . . . . . . . . . . . . . . . . . * * * ' ' * ' ' * ' Name of Former Owner . . . . . . . . . . . . . ... . . . . . . . . . . . . . . 11. Zone or use district in which premises are.situated . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ........ . . . . . . . . . . . . . . . . . . . 12. Does proposed construction violate any zoning law, ordinance or regulation: . . . . . . . . . . . 13. Will lot be regraded . . . . . . . . . . . . . . . . . . . . . . . . . . . . Will excess fill be removed from premises: Yes No 14. Name of Owner of premises . . . . . . . . . . . . . . . . . . . . Address ... . . . ... . . . . . . . . . . . .Phone No. . . . . . . . . . . . . . . . Name of Architect . . . . . . . . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . 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. 6ou Z'L C> N _ a �, b STATE OF NEW YORK, S.S COUI Y OF . . . . . . . . . . . . . . —. 4 . . . . . . . . . . . . . . . . . . . . . . . . . . being duly sworn, deposes and says that he is the applicant (Namaf individual signing contract) above named. Heis the . . . . .6w . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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. . . . . . . . . . . . . . . . . . . .119 Notary Public. . . . . . . . . . . . . . . . . . . . . . . . NOTARYPYAL 96. 52-5792t I suftilt County I C (Signature of applicant) VA FORM NO. 1 i TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWMHALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined . . . . . . . . . . . . . . . .. 19 . . . Application No. . . . . . . . . . . . . . . . . . Approved . . ... . . . . . . . . . . . .. 19 . . . Permit No. . . . . . . . . . . . Disapproved a/c . . . . . . . . . . . . . . .' . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . (Building Inspector) APPLICATION FOR BUILDING PERMIT _ Date . . . . . . . . . . . . . ., 19 . . . INSTRUCTIONS a. This application must be completely filled in by'typewriter or in,ink and subm}tted 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 occup k(A 60d in whole or in part f(Oa nurp&whke�er until a Certificate of Occupancy . shall have been granted by the Building Inspector. APPLICAT � 1]1) p�Tt li o�r t, '��£�a$aiil lin ursuant to the Building Zone inance of the Town of Southold, S lla0unty, N8 York, and other applicable La inances or Regulations, fo a construction of Builaing;s, additions or altera s, or for rem o i or em ion, r in described. The applicant grees:to comply,with all applicable laws, ordinan , building code, housing code,Wand reg ih tions, and to admit authoriz(d inspectors on premises and in buildings for neces@zZ inspections. t ". . . . . . . . . . . . . . . ignature of aVI16ant, r ame, if'a c r oration) . . . . . . . .. . . . . . . . . . .) Mailing adder` s ap DA PAD State whether 'Vpplicant is owne , lessee; agent, architect, engineer, general contractor,19 ct ician, p lu b rro�or biulder. . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . : Namef1bjwnei o premises,' . l `�t!. . :. t �l�r . . `. . . . . . . . . . . . . . . . . . . . . . . . . . . . �,/ (as on the tax roll or latest deed) If app�ka§is a ci ration,"si nVturg o? u y a'u horized officel•.( . . . . . . . . . . . . . . . (N fand title of rporate officer) Builder's t4pse No. . . . . . . . . . . . . . . . . . . . . . Plumber's License No. C!it 47 4z, Electrician's License Nk TO d Z. . . . . . . . . . . . . . . . Other Trade's License No. . . .. . . . . . ... . . . . 1. Location of land on which proposed work will be done. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . �A-ova S . ... 1. . . . . . . . . . b>!. s� . .sC.�a... .. . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., . . . . . . . . . . . . . . ... House Number Street Hamlet County Tax Map No. 1000 Section . . . . . . . . . : . . . . . . Block . ... . . . . . . . . Lot .'. . . .`. . . . . . . . . . Subdivision . . . . . . . . . . . . . . . . ... . . Filed Map o. . . . . . . . Lot . . . . . . . . . . . . . . . (Name) -� 2. State existing use and occupancy of premises a intended use and occu cy of proposed construction: a. Existing use and occupancy . . . . . . . . . . . . . . .. b. Intended use and occupancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .