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Home My WebLink About4236-z FO~M 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? 4236 Z Permission is hereby granted to: ............ ~.52.....~.:.....t2...~.~..~.~. ............................... .............. ~ .,. ~m~..~ ...s..~.~ ...................... to ......... ~ ~..~.....~.~.~.....q~,~,....~..~ ~,~,~' .~,.~.e.~ ;[~T~' . ...... at premises located at ......................... ~....~[~.~,~..~/'~ ....................................................... .................................................................. ~..e.~.o~ ...... ~J.~,~., .......................................................... pursuan¢ to application dated .............................. ..~.~,~..],...,..~..0. ........ , 19..~.., and approved by the Building Inspector. h ......... /..I...~.....~..%¢ ......... ;.%......'.~..~ .~..~...~-/~ ................ Building Inspector I ~FORM ,NO. I !~ ~.~/~B ~ %~ TOWN OF SOUTHOLD BUILDING DI~PARTMI~-NT TOWN CLEiRK'S OFFICE SOUTHOLD. N. Y. xamined. Application ................. Disapproved a/c '. ~ :':::...' ....... (Building Inspe~er) APPLICATIO,~ FOR BUILDING PERMIT INSTRUCTIONS a. This applicati.on must be completely filled in by typewriter or in ink and .submitted in duplicate to the Building Insped0er. b. Pl~ot plan showing location of Lot and ~f buildings o n premises, relati~onship 1~o adj~oining premises or public streets ~er 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 applicatim~ may not b e commenced before issuance of Building Permit. d. Upon approval ~of this application, the Building Inspecbor will i,ssue a Building Permit .to the applicant. Such permit shall be kept .on the premises available for inspection through,out lhe progress .of the w, ork. e. No building shall be occupied or used in whole 0r in part [or any purpose whatever until a Certificate ,of Occupancy shall have been granied by the Building Inspector, APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant t.o the Building Zone Ordinance of the Town of S~uthold, Suffolk C~unty, New %erk, and other applicable Laws, Ordinances or Regulations, for the construction zf build ings, additions or alterations, or f~or removal or demo- lition, as herein described. The applicant agrees to corn ply with all applicable laws, ~ordinances, building code, h.gusing code, an, d regulations. ~ ... ~..~.~.~ .~.. ~lz. ~ .o..Z.~. .......................... (Signatu.re .of .applicant, or name ff a eorperati~n) ; ~tation ........ 2~?. E,..~.?. St;.. Htu~t:~n~t~n.. I~.,Y, ..... i (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, genre'al contractor, electrician, plumber or builder .............. 01/~1~1'..,~. ~llt[[e~'. ................................................................. Name .of .owner of premises .... L~iq~f~ .I, fl~ .,~.,~t. 0£he:~ ........................................ If applicant is a corporate, signature of duly auth~orize d .officer. (Name and title of corporate officer) i 1. Location ~of land on which proposed w, ork will be done. Map No.. ~ Lot No...~. Street and Number ... ~/.~1...~t~haieis~t.gt~®'. ....... (}I'.e~lq.poI',~.. I~I,~ .......................... Municipality 2. .State existing use and .occupancy ~o{ premises and intended use and occupancy of proposed construction. a. Existing use and occupancy ...... ~,'~.~.$;~t;. ~q(~ ................................................ b. Intended use an~d ~ccupancy ...... O~e. £a~212~~. ~e~,[t.~ .................................... 3. Nature of work (check which applicable): New Building ...:~..... Addition ........ Alteration ........ Repair ......... Removal ........ Demolition ........ Other Work (Describe) ...................... 4. :Estimated Co.st .... l~r ,000.~ ............... Fee ]~1,00 .......................................... (to be paid ,~n filing this application) 5. If ,dwelling, number .of dwelling units . ~ ..... Number ;of dwelling units on each floor .............. :If g.arage, number .of cars ...~ ................................................................... 6. If business, commercial ,~r mixed occupancy, specify nature and extent ,of each type of use .............. 7. 'Dimensions of existing structures, if any: Frsnt .............. Rear ............. Depth ............. Height ................ Number of Stories ........................................................ Dimensions .of same structure with alterations OF additions: Front .............. Rear ............... Depth ................ Height ................ Number of Stories ..................... 8. Dimensions ~of entire new construction: Fr~nt .... '3~' ,,,~0 .... Rear .. 3~,,.~0 ..... Depth .. ~-,~1.0. · Height ............ Number ,~f Stories . .~,.. (l~]..~l~. ~h.) ....................................... 9. Size of ~ot: Front ...9~ ......... Rear .... ~0..' ...... Depth ...~00 ........ 10. Date of Purchase ..... ~(~ ..................... Name <~f Former Owner .. ~;,.1~ .~. l~e .......... 11. Zone .or use district in which premises are situated....~&.~...~I~.~. ...................................... 12. l~oes proposed construction violate any z,3ning law, ,ordinance,or_r~p~qlat]on? ...... ~ ................... 13. :Name ,of Owner.o~ premises , .~'~'eI~oe. Li~. &d~t~l~'...~ ......... T~ne No ............ 'Name of Architect ............................. A~ddress ...................... Ph,~ne No ............ Name ~of Contractor .... ~11~ .................. Address ...................... Ph,{me No ............ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing ,or 'proposed, and indicate all set-back dimensions from pr~,perty lines. Give street an,d block number ,~r de scripti,on according ~o deed, and show street names and indicate whether interior ,or corner 1.et. STATE OF N~W YORK, )S.S. COUNTY OF . ~O~k...) .............. ~'~/X'~(~..~i~O. ~.~' ................ being duly sworn, ,d~poses and says that he is the appli- (Name 4of individaal signing application) cant above named. He is the ........ ~...~..~l.'~.~. ................................................ ((~ontrac*or, age~t, o~r~porate officer, etc.) of said owner or ,owners, and is duly auth.orized to pe~rm or have performed the said w,o~k and to, make and file this application; that all statements oontained in this application are true to the besl of his knowledge and belief; and that the w,~rk will be performed in the mann er set forth~ in the application filed therewith. Sworn to before mo this .............. 10. day of ....... A.p~.~.~. ...... 19..69 N~tary Public ...... ~~. ..... County ~"~~'"'~'(Si~ture of ap~licant)'r'~ ' .................. ~OTARy PUBLIC, St~te of ~w YO~ ~NO. 52.8125850, gu folk C0u ~