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HomeMy WebLinkAbout3777-z FOI~I NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT fi.HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 3777 Z Permission is hereby granted to: ,~,~. ,,.~a...M~..~...~.rrr... ................ .............. ~-~...~.~ ......... ~ ...................... ........................ ."...,.~.~ .............................................. to ~.X~ ~ ~,~:t.t.~. ~. ~ ~.,.t.~ ~. ................... - ......... at premises located at .................. ~ ................................................... :. ............................................... ............... .~..~'l,.~..~m~ ....... ..r.~.~..,.x.~.....~.:~.,. ................................. i ................... pursuan¢ to application dOted .......................... ~..,,..~ ..............., 19;..~., and approved by the Building Inspector. B uC~ild~n~g I :nspector FO~M NO. 1 Examined .....~ .................................. , 19 ........ 'i~OWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 19 ........ Permit No ........ Disapproved a/c ............... ~'~L ~ .................................. '" (Building' Inspecto/) ................................. Application No ............................. 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 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 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 Per,it pursuant to the Building Zone Ordinance of the Town of Southoid, 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 and regulations. A. O'olm Oad~ ~eneral Co~t3mc~, Inc. (Signature of applicant, or name, if a corporation) Dra~ B ~Xehers Zel~,, ~e~ ~o.,"k 06390 (Address of applicant) State whether applicant is owner, lessee, agent, architect, engi.neer, general contractor, electrician, plumber or builder· ~eneral Name of owner of premises ................................................... ..~..a/..l~..~.~t..~....~...,...~..~..~....~ .......................................................... If o~ont ~c~orate, signoture~ of~ authorized officer. y(Nome and titJe of corpo/~te officer) Municipality 9. State existing use end occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy J[~l~&~l~ b. Intended use and occupancy ~8~e~c~e ~'~ ~,0~/~ ~ · 3. Nature of work (check which applicable): New Building .................. Addition ...,ill ........... Alteration Repair .................. Removal .................. Demolitian .................. Other Work (Describe) ........................................ 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 ...........~. ................................................................................................................... i ........... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ...JJ.l~.t..~ ............. Rear ..... ~0...~ ................. Depth .................... Height ........................ Number of Stories ............~,. ...................................................................................... i ........... Dimensions of same structure with alterations or additions: Front ........ SO.i.~ ................ Rear ....... ~O..J ........... Depth ......~.JJ.I. .................... Height ............................ Number of Stories ......... ~ ..................... 8. Dimensions of entire new construction: Front ............... ~JJ ................ Rear ...... J~J ................. Depth .~.~...~ ................. Height .................... Number of Stories ...... ,J, ............................................................................................................. 9. Size of lot: Front ...~.~:~.? ................ Rear ........... .~.~.~.~ ................ Depth 10. Date of Purchase ..~...i~l~l~..~...].J.,....~J~. ................ Name of Former Owner .~.~....~...~...~..~.....~..~.....~....~....~..~. ................ 1 1. Zone or use district in which premises are situated ................................ I~..~1~ ................................... ! ........... 12. Does proposed construction violate any zoning law, ordinance or regulation? ............ JJ~ .......................................... 13. Name of Owner of premises I~...j~.j~.~...~l.J~.iR~ .........Address~..l~l..~...~.~.~.~.~.~..~.~..?.. Phone No..~.?...t~....~..~...~.~.. Name of Architect ......... .~.~ ................................... Address ............................................ Phone No ......... ! ........... Name of Contractor &.,...~..~....~...~. ,.~....~.~.....~....~...~...~ddress .~..~..~..J~....J'.~..~..~..~...~..~.~.l~.?..~..*Phone No. ~.l~J~.?.2]l. 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 whether i.nterior or corner lot. STATE OF NEW ¥~)1~, COUNTY OF~.: ............... ................ ~~..~' ....: ..................................... being duly sworn deposes and says that he is the applicant -(Narh'e of individual ~igning application) ~//, . . above named He s 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 ond 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. Swam to b~fore me this ....... .......... ................. Notary PubJict~.../,.l~~/~:i;i:.,¥.' .............. C::: '~ ........... ~(~['g"n'~¥'L~i~';"(~'f'"(~'J~'~ii~'~ ..................... ,?