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Home My WebLink About4180-z FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT ('rills PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 4180 Z Permission is hereby granted to: ................... ~.~.~a~. .............................................. to ..l~d~l..J~..e~e..fe~d~..~l~e.~.tlslJ .................................................................................. at premises located at .................. ~.~.....J~LI~..JJ~! ...................................................................... ............................................................. ~l',te~ ......... IIoZ. ................................................................. pursuon¢ to application dated ....................... eJ~ ......... 3'~J ................ , 19....~1/I~ and approved by the Building Inspector. Fee $.-.~Oe-0~ ......... mmld~ng Inspector J ,FORM ~NO, I TOWN OF SOUTHOLD BUILDING DI:PA~T TOWN CT~tI['S OFFIC]; /~ SOUTHOLD, N. T. Examined .,~:;~ ~ ~ ~ ......... .... ............. .......... .......................... (Build~g Iuspec~) Application No ................. APPLICATION FOR BUILDING PERMIT ;;an,,~T 31 69 Date .................................. 19 .... INSTRUu'nONS 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 o n premises, relati~amhip tn ad~oining premises or public streets or area~ and giving a detailed description of lay out 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 In spector 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 o~ in pa~t f~r any purpose whatever until a Certificate ~ Occupancy shall have been granted by the Building InspectOr. APPLICATION IS HERI~Ry MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of S~uthold, Suffolk Oounty, New York, 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 cam ply with all applicable laws, ordinances, building code, housing code, amd regulations. Orient ................ '&' ................ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or OWlleF builder ................................................................................................... William Heina Name ,of owner of premises ............................................................................... If applicant is a corporate, signature of duly authorized officer. (Name 'and title of corporate officer) 1. Location of land on which proposed work will be done. Map No ................. Lot NO .............. 8/S Ma:in ~oad Orient N.Y. Street and Number ................................................................................ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed oonstruction. · acant: land a. Existing use and occupancy .................................................................... same with one family dwelling b. Intended use and eccupancy ................................................................... 3. Nature of work (check which applicable): New Building .. ~g~g.. Addition ........ Alteration ........ Repair ......... Removal ........ Demolition ........ Other Work (Describe) ...................... 4. Estimated Cost . '%2~00~ '_.+ ................... Fee '$Oa00(to ............................. be paid on filing this applica~i~) ......... 5. If dwelling, number of dwelling units . O~ .... Number of dwelling units on each floor .............. If garage, number of cars ....... ~/'O .............................................................. 6. If business, commercial or mixed occupancy, spec ify 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 alterations or additions: Front .............. Rear ............... Depth ................ Height ................ Number of S~ories ..................... 8. Dimensions of entire new construction: Front ..... 38 ......... Rear .. '38 ........ Depth . 2~-~'*" ' Height ............ Number of Stories ............................................................. 9. Size of lot: Front . .$~0 ......... Rear . 4~0...' ...... Depth . '~00 ......... 10. Date of Purchase ............. .~-96~ ............ Name <~ Former Owner .... H... · .I~ha~ ............ 11. Zone or use district in which premises are situated ...... ".AP. · cl~l, St .................................... 12. Does proposed construction violate any zoning law, ordinance or'regulation? ......... ~ ............... 13. Name of Ownerof premises ~i~l'2iata · H~il~ · · · A~ldress .... 0~':~el~ .......... Phone No ............ Name of Architect ............................. .~ddress ...................... Phone No ............ Name of Contractor .... T...l~o~kl~A~ .......... Address .... 01~t~5% .......... Phone No ............ 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 interior or corner Sot. ! 5'0 STATE OF NEW YORK, )S.S. COUNTY OF ..... ) ............... ~/.~l~.~mm. .~e~.~. ..... : .............. being duly sworn, deposes and says that he is the appli- (Name of individt~al signing application) cant above named. He is the .... ~e~ ............................................ : .................... (~ontraetor, agent, col'porate officer, etc.) of said owner or owners, and is'duly authorized to per{orm or have performed the said work and to make and file this application; that all statements contained in th is appli0ation a~e true to the be~t of his knowledge and belief; and that the work will be performed in the mann er set fort~ in the application filed therewith. Sworn to before me this ........... 3.~... day of ...... ~%~.1'~'... 1969. MARION A. R~GEN~ NOTARY PUBLIC, Stale of New Yo~k No. 52-3233120 Suffolk County Term Expires NTarch 30, 19,~.~