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Home My WebLink About4478-z FOl~'/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) N? Z Permission is hereby granted to: - ~,V,~yt®.-..&/C-.-.Ge~--D~',,-Lo~ ............. ............. Z~.sh~rs..Z, slanct ................................ to ............. ]/l~fl. ld ..~l~&te...ga~.a~e...¢Aea e~ s e~y...~14~,) ................................................... ....................................... .(Ap~t,,~re~l..h3r..2/L..of..Ap~eel$) ........................................................ at premises located at ............... ~:~lt~..~C~ ......~.~[-,Frg~ .......... ~,"'30"3 ..................................... ......................................... F.~h~.~..l~la~d.v....~,~., .................................................................... pursuc~t to application doted ........................ A~ .......... %~ .............., 19.~9.., and approve~ by the Building Inspector. Fee $. ~..'. ~ ............. ,FORM ,NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CL~:~RK'S OFFICE SOUTHOLD, N. Y. Application No ............. APPLICATIQ.~ FOR BUILDING PERMIT Date .......... '~ .... !.? ....... 19.~- ~' INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and .submitted in duplicate to the Building Inspeckrr. b. Plot plan showing location of l~t and =of buildings o n premises, relationship to adjoining premises or public streets ~r 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 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 on the premises available fo r inspection throughout the progress of the work. e. No building shall be occupied or used in whole o~/n part for any purpose whatever until a Certificate ~f Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEP~EBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Sc~uthold, Suffolk County, New Y..~rk, and other applicable Laws, Ordinances or Regulations, for the construction of build ings, additions or alterations, or for removal or demo- lition, as herein described. The applicant agrees to corn ply with all applicable laws, ordinances, building code, housing code, al~d regulations. if or ' ) ' (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder .... ~~'. ............................................................................... Name .of owner of premises..~ · ~ .~. · ~.~k. · .~. ...................................... If applicant is a earporate, signature of duly authorized ~ffieer. (Name and title of corporate officer) 1. Location of land on which prcwosed work will be done. Map No...~..~.[: ....~..:. Lot No.~. ~.-~. ........ Street and Number // -/ /~0 ~k ~ Municipality 2. State existing use and occupancy ,of premises and intended use and .occupancy of proposed eenstruction. a. Existing use and occupancy ..................................................... b. Intended use .and occupancy . ~-.~..~..~..~I'~. ................................ 10. 11. 13. Nature of work (check which applicable): New Building ........ Addition ........ Alteration ........ Repair ......... Removal ........ Demolition ........ Other Work (Describe) ...................... Estimated C~st ....'. ?./O. D/I:~ ................. Fee ................................................. (to be paid on filing this application) If dwelling, number .of dwelling units .......... Nnmber .of dwelling units on each floor .............. If garage, number of cars If business, commercial .~r mixed occupancy, specify nature and extent of each type of use .............. Dimensions of existing structures, if any: Front .............. Rear ............. Depth ............. Height ................ Number of Stories ........................................................ Dimensions .of same structure with alterations or additions: Front .............. Rear ....... ' ........ Depth ................ Height ................ Number of S~ories ..................... Dimensions ,of entire new construction: Front .... ...... Rear .... Depth .... Height . .I. ~ ?. '..... Number of Stories ...~ .......................................................... Size of l~t: Front ................ Rear ............... Depth ............... Date of Purchase ............................... Name c? F,.~o~ner O~vner ..~.~ ................ Zone or use district in which premises are situated .................................... l)oes proposed construction viola'ce any z,c~ning law, ,ordinance or regulaticm Name of Owner.of prem~ses~.....~..~ .~%.. A, ddress~.~'~..'~....~. ~-i?.- ~hone No ............ Name of ~xehiteet ............................. ~'ddress ...................... Phone No ............ Name Contractor PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or ~proposed, and indicate all set-back dimensi,ons from property lines. Give street and block number ~r description acoording to deed, and show street names and indicate whether interior .or corner lot. STATE OF COUNTY OF . ) ....... being duly sworn, deposes and says that he is the appli- (Name ,of individual signing ) cant above named. He is the ........................ ~~ .................................. (Contractor, agent, earporate officer, etc.) of said owner or ~)wners, and is duly authorized bo perfarm or have performed the said work and to make and file this application; that all statements contained in this application are true to the bes~ of his knowledge and belief; .and that the work will be performed in the mann er set fortl/in the application filed therewith. Sworn to before me this (Slgnture of apphcant) Qualified in Suffolk Coun~ Term expkes M~eh 30, 19 -'l]