Loading...
HomeMy WebLinkAbout2429-Z FOP,,M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 2~29 z Permission is hereby granted to: ...~.~,..~... ~;.. ~ ~..~chol~z ................ ............... ~..~.~.~.e.~ .............................. to .....~a)~;e,..&l~e~.atlo~s,..amd.. at premises located at pursuant to application Building Inspector Fee $.. ~. :, .0. , .0. ............ approved by the g pcor '~ FORM BUILDING DEP.,~RTN~ENT ~' ~ ~ TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E ....... ~.~ .......................... ~ ........ . <, . ' ....................... Approved ...,~ ................ ~., Disopproved o/c .......... .................................................................. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. 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 propertymust be drown on the diagram which is part of this application. 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 progress of the work. e. No building shall be occupied or used in whole or in pa rt for any purpose whatever until o Certificate of Occupancy shall hove been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building D~portment 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, os herein described. The applicant agrees to comply with oil applicable laws, ordinances, building code and regulations. ...... .......................................................................... (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......................... ~.~r. chas.er...by...can,t~.act ...................................................................................................................... Name of owner of premises ..c~a~l..~ay...&..M....Sol~olts ................................................................................................... If applicant is a corporate, signature of duly authorized office~. .................... ................... 1. Location of land on which proposed work will be done. Map No: ............ ~ ................. Lot No: ...~X~X~ ...... Street and Number ....W/.~.....Fnc.t.o:~.....A.v~t ........ l~at.tt..tu¢lc~ ................... : ..................................................... Municipality 2. State existing use and occupancy bf premises arid intended use and occupancy of proposed construction: a. Existing use and occupancy ........ T/&O~Zl.~...].alld. ......... ~/....$OlIIG...I~'LI~I.f.~I§~ ............................................. b. Intended use and occupancy ........ ~J~G...~.1.-~.~..d~.~..]~.~j-'~n-~...j'.~D..~`~..~4.~.:~:~..~.~d~ ........... 3. Natbre of work (check which applicable): New Building .................. Addition ....~[,1~.... Alteration~...,,~, Repair .................... Removal .................... Demolition .................... Ot~ler'~/Vorl~idDes¢l:ib~)ll. .JJ, .. ~,.. ~ . 4. Estimated Cost .....'~: .................. T ................................. Fee .............................. ~ ........ m..,,,~ ............ ~.....L,~.....'.?,~... (to be paid~l~ fiti~j~l this~ppl~ic~tiol~)~ 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 ............. ~.Q...~./~Rear .......... ~..~../..~... Depth .... .]'..~.....~,~'..¥. ..... Height ............................ Number of Stories Dimensions of same structure with alterations or additions: Front ....... ~,.~ .................... Rear ~0 Depth ....... ..~0 .................. Height .............................. Number of Stories ........................................ 8. Dimensions of entire new construction: Front .......... ~ ............. Rear .......... ~.CL...~ ........ Depth ............ ~ ....... Height ............................ Number of Stories ...... ~(i ................ 9. Size of lot: Front ,..1,Q0 .................. Rear ......... ~I,.QQ ............ Depth ......... ~ .0~...~. ,/.~. ........ 10. Date of Purchase .............~,~.~. ................................. Name of Former Owner 11. Zone or use district in which premises are situated .................. ~......~l,~.t~ ..... 12. Does proposed construction violate any zoning law, ordinance or regulation? ........... ~. ~3. Name of Owner of premises .~..:....~...~.~...&....~..;....~...~..~...O..]~ress ........... ...-l~....tt~...~..~.~.O..~.. .......... Phone No. Name of Architect ...................................................... Address ............................................. Phone No. Name of Contractor ..~,~!tl~..~l.~. ................................. Address ....... .~..~..~..~.~.~. ............... Phone No. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions property lines. Give street and block numbers or description according to deed, and show street names and whether interior or corner lot. ' ' ~ ........appllc( STATE OF NEW YORK, ~ e c COUNTY OF ..1~.~.o.1.~ ........... .f ~'~' .......................... ~..~..~..~...~ ...................... being duly sworn, deposes and says that he is the (Name of individual signing application) above named. He is the ...~8~e~...~Q~..~o~,.....~..g~/...~Z~e~...o~..~.~ ................ (Contractor, agent, corporate officer, etc.) of said owger or owners, and is duly authorized to perform or have performed the said work and to make and f this application; that all statements contained in this application are true to the best of his knowledge and beli~ and that the work will be performed in the manner set forth in the a~licgtJ~n~ therewith. Swornz. jt~efore me this ~ 19~..~. ~~~~'~ '-~ ........ .............. dayof .............. ............ , ~~~~~.~.~ ~ ' ~ R~ ........... ~ ...... .... , .............