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HomeMy WebLinkAbout10298-Z FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE � SOUTHOLD, N.. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PTZEMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N910298 Z Date ........................: ./.VY ..�....... .. ., 1977. Permission is hereby granted to: ....�.� S 3 F-t 7i 0F� Civic ASSOC --r-r O r, .��'.................................. ..........�.............��5 ............ a... .. ?.r:.1 .!?.!:f............................ ...................... -rc. ,............`. t A to .............. Up.7A)...........A......... 4 =............� �1 a L !.r-..................................... ................................................................................................................................................................ atpremises located at .................... .. ............................................................................ .................... .... ...........�,ay..-.-.....:,,..................................... ................................................................................................................................................................. Pam. pursuant to application dated .............................el.00.............., 19.....�., and approved by the Building Inspector. Fee $. .f U................ r ................ ....... ..J ........ .r °n ? " 000 1-� Building Inspector i;e � L.t;r- q 13 d /� of FORM NO. 1 TOWN OF.SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined . . . . . , 19 7. 7 Application No. . . . . . . . . . . . . . . . Approved . . . . . . 1, 197IPermit. No. Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... .. . . . . . . . . (.uilding Inspector) APPLICATION FOR BUILDING PERMIT .7��j 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 nspections. . _ . . . . . . . . . . . . . . . . . . . . .(� . (Sign ur of applicant, or name, if a corporation) 1�6 ( ailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. %!►PPR S NOTED . : . . . . . . . . 4 Name of owner of premises ... . .DATE. . . . . . . . . . . . (as on the tax roll o e ee FEE: BY: If.ap?des po , signature of duly..authorized officer. NOTIFY BUILDING DEPARTMENT AT 765-2660 9AM to 4PM FOR REQUIR- nd title of corporate officer) ED INSPECTIONS; i1. BEFORE BACKFILLING FOUNDA, nse No. TION OR START FRAMING �'. . . . . . . . . . . . . . . . . . . . . 2. FRAMING INSPECTION Plumber's License No. 3. BEFORE COVERING PIR. S OF ANY KIND 4. FINAL WHEN JOB COMPLETED Electrician's License No. NOT RESPONSI3LE FOR DESIGN OR CONSTRUCT ION ERRORS Other Trade's License No. . . 5. ALL CONSTRUCTION MUST MEET RE UIRE NTS OF N.Y. STATE CODE 1. Location of land on which proposed work will be done. . . . . . . . . . . . . ... . . . . . . . . . . . . . House Number Street Hamlet o S 1 County Tax'Map-No. 1000 Section . . . . . .r ` P. . .. . . . Block . . . . . —5 . . . . . . . . . Lot . . . . ! . . . . . . . . . . . Subdivision . . . . . . . . . . . . . . . Filed Map No. . . . . . . . . . . . . . . Lot . . . . . . . . . . . . . . . (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b. Intended use and occupancy . . C . . . . . . . . . . . . . .1t1A3. . . ��4. . . . . . . . . . . . . . . . . 3. Nature of work (check which applicable): New Building ' . . ... . . Addition . . . . . . . . . . Alteration . . . . . . . . . . Repair . . . . . . . . . . . . . . Removal . . . . . . . . . . . . . . Demolition .. . . . . . . . . . . . . . Other Work . . . . . . . . . . . . . . . (Description) 4. Estimated Cost . . . . . . .— } . . . . . . . . . . . . . . . .'. . . . . . . .. . . Fee . . . . . /.0. . . . . . . . . . . . . . . . . . . . . . . . . . . (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 . . . . .. . . .. . . .f. . . .. . . . . . . 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 64"YAGt~+. . . . . . . . . . . . . . . . Will excess fill be removed from premises: Yes No 14, Name of Owner of premises . . . .T2J.¢/� . . . . Address . . . . . . . . . . . . . . . . . . .Phone No.z fI5 �1.�;.--- 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 whelp C .interior or corner lot. $t�rJAA1� �V 1— Ci2o Ss I �f cTlo(-A 0 j coNSTRV— 0114 f I � VAVO-k too) STATE OF NEW YO S COUNTY OF,. . . '. . . G :4 . . . . . . .\Ja h . . . . . . . . . being duly sworn, deposes and says that he is the-applicant (Name of individual signing contract) above named. Heis 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 . . . . . . . . . . . ., 19 Notary Pu ic. . . . . . . . . . . . . . . . . . . . . . . . . . . . County ( r BABETTE C. Gogppy. . . . . . OTARY PL'ALIC,State of New perk. Suffolle County kd,Ado-S oca (Signature of applicant) Caminfssi®n faapWg ilcorah go,19 FY