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Home My WebLink About4137-zTOWN OF $OuTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFF[CE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISE COMPLETION OF THE WORK AUTHORIZED) UNTIL FULL N? 4137 Z Permission is hereby granted to: .,,d.r,~.,,:~...:, ~..~..,,.:2 2. :] Z:..~?.....&:,.~/..C .!,¥:,.../.T.~.~,/~ Z;' ..................................... z2.~:.l..~..~/..~): ................... at premises located at ..................... ~..zI. ZI,.F./..M/ ............ I.k'],Z;.~ILZ~ ................................... .......................Z ~ Z ~,~: ~Z t pursuan¢ to application dated .......... ~....~/~.~.~.Z~.~.[~, and approved by the Building Inspector. Fee $ ........ .A... .......... ,FORM :NO. I TOWN OF SOUTHOLD BUILDING D~I3ARTI[~EN,T TOWN CI~RK'S OFFICE SOUTHOLD, N. Y. Appro.vcd ~ -~ A/d.~.~, 19 .... r'ermit No .................... Disapproved a/c ..... ~.~;~ · .~.~~ · .............. APPLICATIO;N FOR BUILDING ~ERMIT Date ............ ..... INSTRUCTIONS a. This application must be c.ompIetely filled in by typewriter or in ink and ~submitted in duplicate to the Building Inspector. b. Pl~t plan showing location of let and :o~ buildings o n premises, relati~anship go adjoining premises or public streets ~r areas, and giving a detailed description of lay out of property must be drawn ~on the diagram which is part of this application. c. The. ~vork covered by this application may not b e 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 ton the premises available for inspection throughout the progress ,of the w, ork. e. No building shall be occupied or used in whole o~ in p~rt f~' any purp;ose whatever until a Certificate ~f Occupancy shall have been granted by the Building Inspector. APPLICATION IS HER/gBY MADE to the Building Department for the issuance of a Buff,ding Per-nit pursuant to the Building ~Sone O~dinance of the Town of S,~athold, Suffolk Oounty, New Y~3rk, and other applicable Laws, O~dinances ~or Regulations, for the construction of build ings, additions or alterations, ~r f~or removal or demo- lition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, h3using code, an, d regulations. ' ' 'i~i'~i~ 'a'nt', 'o~' name if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, ggllp_rl~L~I~a~, electrician, plumber or builder .................................................................................................... Name ,of,owner of premises ~o~°L'~.~.V.~ ~tq~l..' Yaer ~,~]oo~ ~[S'~'~ If applicant is a corporate, signature of duly authorized <ffficer. (Name and title of corporate officer) 1. Location ~of land ,o~ which pr~p,o,sed work will b e done. Map No ................. Lot No .............. Street and Number ................................................ ~'i~tp;l{i~ .................... 2. .State existing use and ,occupancy ,o~ premises and i~tended use and .occupancy of proposed const~ction. a. Existing use and occupancy .................................................................... b. Intended use and ,oeeup~ey ................................................................... 10. 11. 12. 13. Nature of work (check which applicable): New Building ........ Addition ........ Alteration ........ Repair ......... Removal ........ Demolition ........ Other Work (Describe) ...................... F.stimated Cost ......... ~,.7. ~ ?...~ .......... Fee ...... .YT...o. ~O ~ ............................ (to be paid <m filing this application) If ,dwelling, number .of dwelling units .......... Nnmb~r ,of dwelling u, ni~s on each floor .. ~ .......... 'If garage, number of cars .............. .~../'f.~.~. .... .~. ...... .O..~.1~.--..~../-/...~..~. ?. ...... .~..~_20.~..~ ....... if business, commercial ,~r mixed occupancy, specify nature and extent of each type of use .............. Dimensions of existing structures, if any: Fro, nt .............. Rear ............. Depth ............. Height ................ Number of Stories ........................................................ iDimensions ,of same structure with alterati, ons ~o.r additions: Front .............. Rear ............. 'Depth ................ Height ................ Number of S~ories ..................... Dimensions ~of entire new construction: Front ........ ~...~..... Rear .... .~-...~w.. .... Depth . ~ .~. .... 'Height .... [..~-.[ :~... Number ,~f S~ories .......... /~..~...~.'~. ........................................... Size of }or: Front .... ..~..~...~'.... Rear ............... Depth ............... Date of Pureh.ase ............................... Name <~f Former Owner ............................. Zone ,or use district in which premises are situated ............. .~, Does propased comstruetion violate any z~ning law, ,ordinance. or regulati,n? ...... ?..? ................. Name ,of 0wrier,of premises .................... .~'Address ............. ~'.. ...... Phone No ............ Name of Architect ............................. ~ddress ...................... Ph, one No ............ Name ,of Contrac~o.r ,~./::.~. '.~.~......~./.~./..'~..~. ...... Address . .~..]..L~..~..'T. ........... Phone No?.2..~.....~..~. / ~{ PLOT DIAGRAM Locate cl.early and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from preperty lines. Give street and block number ,or description acoording to deed, and sh~w street names .and indicate whether interior ,or corner l~ot. A STATE OF NEW YORK, )S.S. COUNTY OF .............. ) ......... . .~..~..~.?..~. ....... .P~..~./..~..~. ............... being duly sworn, ,deposes and says that he is the appli- (Name of individual signing application) cant above named. He is the ................. ~L/T'~'A ~_~-~d ..~. (©ontrae~or, agent, o~cporate .officer, etc.) of said owner or ~owners, and is duly author/zed to pe~,grm or have performed the said work and to, make and file this application; that all statements ~ontained in th is application are true to the bes~ of his knowledge and belief; and that the w~grk will be performed in the mann er set ~orthl in the application filed therewith. Sworn t.o before me this ................ day of ........ l~rtary Publ/c,~. '/~ .a~..,~. ;?. ...... C: ~ ~' ;r ~'n~t~ ~O;']-;t-t~ ............... ~g: .......... re ; .................... t, MARION A. REG[Nr NOTARY PUBLIC, State of New York T~rm Expires IVlarch 30, ~9~/