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Home My WebLink About3897-z FOl/~I NO. 2 TOWN OF SOUTNOLD ~ BUILDING DEPARTMENT TOWN CLERK'S OFFI~:E SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 3897 Z Permission is hereby granted to: pursuan¢ to application dated ........................... ~.~ ....... ~-~ ....... :i..,.., 19..~ end approved by the Building Inspector. i, Fee $..~.0,~[ .......... ~ Buildin , · ~g Inspect°rl ~k TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTNOLD, Examined ...... ~,~ ..... ~, 19 ........ Approved ........................................ , 19 ........ Permit No ...................... Disapproved a/c -":z, .............. ~.'~'~ ...... !.-. ....................................................................... y..;,.,,.~:~ ............................... ........... ' ..................... ~, ~-~ %~ '--"i' T'"' *'"-"-" ................................ APPLICATION FOR BUILDING!PERMIT Dote~ ........................ ~ ..........~.~. ............ , 19.~.~ ....... INSTRUCTIONS a. This application must be completely filled in by typewriter or ir~ ink and submitted in duplicate to the Building Inspector, b. Plot plan showing location of lot and of buildings on premises, re ationship to ad oining premises or public streets or areas, and giving a detai ed descr pt on of layout of property must be drov~n on the d agram wh ch s part of thi~ application, c. The work covered by this application may not be commenced b~fore 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 pr~gress of the work. e. No building sh~ll be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shell have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for tee issuance of a Building Permit pursuant to the Bu,lding Zone Ordinance of the Town of Southoid, Suffolk County, N~W York, and other appl'cable 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 all applicable laws, ordinances, Building code, housing code, .and regulations. .c..~.~.L'...~.[.~e.~..t..z... ~.e..e. ................................ (Sighature of applicant, or name, if a corporation) ..... t~ox..1523.~...~tL;.~8.,..~l~e~he~,...~.,Z,, ................. (Address of applicant) State whetherappllcant is owner, lessee, agent, architect, engineer, g~nera[ contractor, electrician, plumber or builder. ................................. ~?,~,..o,.......o.~.e. ~. .......................................... : .................................................................................. Name of owner of premises ?.h..$,Z.,~t.~...~.$~...r. ea~.e. ......................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work wiff be done. Map ~o.: ,.~,~..~.~..~.... Lot No.: ]~ ................ ~ ~eda~ ~o~t ~S~ O~ 8outho d N,~ Street and ~umber ........................................................................... ~,..S ........... f. ............................................. Municipality 2. State existing use and occupancy of premises and intended ~se and occuponcy of proposed construction: a. Existing use and occupancy ...~,.~ ................ J ..................................................................................... b. Intended use and occupancy ...O~e...~$~..~:~ ................................................................................ 3. Nature of work (check which applicable): New Building ...;:lf~i~ ..... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ,...8.~.~1~0..~, ....................................... Fee ..... ~..0.~.0...0. ......................................................................... (to be paid on filing this application) 5. ]f dwelling, number of dwelling units ...... ~1~ .............. 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 a,[terations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ $. Dimensions of entire new construction: Front ........... ~.~ .................... Rear .....(~ID. .................. Depth ..'J.~......2~ ..... Height .................... Number of Stories .......... O~ ..................................................................................................... 9. Size of lot: Front ....~.,~. ................... Rear .............. ~1~ ................. Depth ........ .'1~0~....~.~,0, 10. Date of Purchase .............~9..~..~.. .................................. Name of Former Owner ............ .0.~Iit.~,~...~1~ .................... 1 I. Zone or use district in which premises are situated ,.,.l.l.A.~...l~,l~.t* .............................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? ........... I~ ........... ; ................................ 13. Name of Owner of premises ~.~.:L~1~...0j.~G. Address ............................................ Phone Na ..................... Nome of Architect ...................................................... Address ............................................ Phone No ..................... Name af Contractor ....~..~,..~..~..!..B.....~..O.,,~.,~,..~....~...O..~...~,~......Address .~.~....~..~.....-.~.~..~...~.~...~.-~.~,,~. ..... Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fram property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEV~.¥JDJ~-...~. } ¢ c COUNTY OF .,?;.",."~/.?..?.~ ............. ~'~'~' ............................ ~.~.~,,~,~ ........................................ being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ............... .~g~..~...~Og~.~ ........................................................................................... (Contractor, agent, corporate officer, etc,) of said owner or owners, and is du¥ authorized to perform or have performed the said work and to make ~nd file this application; that alt statements contained in this application ~re 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 ~ . . of 68 Y' ................ ....... a y ................ ~ ....................... , .......... ~ .... ...................... ~ /~ ~//~ ~ ~ ~ aunt ' (S gna ure of app cant) Notary Publ'c .........,:'r ...................... ~~ y ~ ' ~¢' ' I~¢~-~J~, State of New Yor~~ ~/} No. 52-0618100 Su folk Ccu,;~ _ /