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Home My WebLink About1784-z FORM NO. ~ 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) pursuant to apphcat,on dated ....................... ~ ...... ./..~.. ..... 19~,,~...-~., and approved by the Budding Inspector Fee $.C.~ Disapproved o/c ............~......~ ................ / (Building lnspecfor) t ' 52, ' :::'. ':: APPLIGATION FOR BUILDING P::RMIT~ ' - , INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plat plan showing location of lot ~nd of buildings on premises, relationship to adjoining premises or public streets or areas, apd: giving a deta ted descr Pt. on of layout of property must be drawn 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 ow n pa rt for any purpose whatever until a Certificate shall have been granted 'by th~a]Tc'i~ng~l~e~?0r:~' . · APPLICATION IS HEREBY MADE to the Building Departmqnt for the issuance of a Building J>ermit'pursuant'to the Building Zone Ordinance of the Town ~f s°Uthold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction c~f buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulatiOns. (Signature of applicant, or name, Jfa corporation) (Address of applicant) ~ . State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder· Name of owner Of pram sas ~:l'Z]-:La'T°' ~-'~ ]~..[c.1-~ .-j~- If applicant is a corporate, signature of duly authorized officer. ................... ................... 1. Location of land on which proposed work will be done. Map No: ~., ,i.~LO.~Jl .....Lot No: . . ....................... 'J.'D.~.~a.' ' ~ '~ .............................................................................................. Municipality 2. State existiog use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing u~e and occupancy' ~ ,. , b. Intended use ond occuFancy .... 3. Nature of work (check which applicable): New Building .................. Addition ....... ~ ........ Alteration ........... ,'.; .... Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................ Estimated Cost ....... J~.0~O~,O ~). ................................... Fee .......................................................................................... / (to be paid on filing this application) · ~ beO. roc~ns If dwelling, number of dwelling umts .............................. Number of dwelling units on each floor .o...z3:.e....~..]...o.,o..~. ..... If garage, number of cars ............................................................................................................................................. If business, commercial or mixed occupancy, specify nature and extent of each type of use ................................ Dimensions of existing structures, if any: Front....]-.~.!. ..............Rear ...... lJ~.! ............. Depth ....1'.6....4 ............... Height ~"~! Number of Stories ode . Dimensions of some structure with alterations or additions: Front ...;~).l. ...................... Rear ..... ~,~. ..................... 12! one Depth P.D. I Height ................................ Number of Stories Dimensions of entire new construction: Front......~.~! .................... Rear ...~z~.~. .................. Depth ....~...~..I. .................. Height ........ ~.~..! .............. Number of Stories ........ .o.~.~.. .................. Size of lot: Front 130 ! Rear 1071 Depth 1151 Date of Purchase .... ..O..°...t;.,...,.~...,t...~g.G..~ .................... Name of Former Owner ..~..~1~.....O~,...~.....]~..~.~, .................... Zone or use district in which premises are situated ................................................................................................. 'Does proposed construction violate any zoning law, ordinance or regulation? ..... ~ ............................................ Name of Owner of premise~J.e..R'l n~:~'~TrJ. ...............Address ~..O[[.~..e,..,T.~.D,e..~,F,~.;~ Phone No~..5...~,~,41~ Name of Architect Z).Q~,~...i3,Q~...~,~D,],~ .................... Address ~.ockv11].e Cor~3., Phone No. Name of Contractor ...... .o...w~_....e.?......,a~......~.~.o...v..e. ............. Address ............................................ Phone No ..................... 10. 11. 12. 13. 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 numbers or description according to deed, and show street naq~es ~3nd'indicate whether interior or corner lot. t STATE OF NEW~Y9~I~ ~ ~ ................ :./~,~~ ............................... being, duly sworn, deposes and says that he is the applicant (Nome of individual signing application) above named. He is the ............. ~..~.~-- ................................................................................................................... (Contract~)r~ agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or~ have 'Pe~f6rmed the said work and to make and file this applicationi that all statements contained in this application are true to fha best of his_knowledge and belief; and that the work will be performed i~ the ~l~bT~n~r %~E/forth in the ~3pplication filed therewith. "~ PIJ~)IIC, State of New York S~w~rn to befOre me this ~ 5~.~344~$3, Suff0m County ~,,/,~ ~/~ ,,~ · ........ ' ...... ........................... ~',~N°ta~ Public~...~..~~~o nty (Signature of applicant)