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Home My WebLink About4941-z FO]~..~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CL~RK'S OmCt SOUTItOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PRE,~iSES UNTIL FULL COMPLETION OFf,THE WORK AUTHORIZED) Permission is hereby granted to: i- .................... g:~u./~h~t./L .......... .:. ............................ ..... R..~ .... ~. ~:. . to ..... ]i~l~...n~...c~...C~ f~..~,w~1:t~, ....... ~.: ............................................................... ..... premises locoted at ......... J~O:t~J~.. i~¢.,~r~..J~L.~J,~JI..,JJ~t~ ................................................. .............................................. :./J~athaltL ...... ~..:.~;~ .............. ~.~ .................................... pursuam tO opplica,tion dated ..... :. ............. ,.?a*~,,~..;...~,....;~..., 19.~..., and approved'by the Building InspectOr. · B~ilding Inspector J TOWN Of~ soU~'NO~D BUILDING DEPARTMlt~T TOWN GLERK'S OFFICE SOUTH~D, N. Y. ~pproved ........................................ , ~9 ........ Permit ~o .......... Application No..~"/../.'...(.~.(. ............ Disapproved a/c .............................................................................................. (Building Inspe~or) INSTRUCTIONS o. This application musL' be completely filled in by typewrite( or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premi~ies, relationship to adjoining premises or public streets or areas, and giving o detailed description of layout of property must be drawn cn the diagram which is part of this application. c. The work covered by this application may not be comment;ed before issuance of Building Permit. d. Upon approval of this application the Building Inspector ~vlJl issue a Building Permit to the applicant. Such permit shall be kept on the premises avai ab e for inspection throughout the progress of the work. e. No building shall be occupied or used in whole or in part {or any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspectar. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ord nonce at the Town of Southo d, Sulfa k County, New York, ~nd other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or aJterdtions, or for removal or demolition, as herein described. The op,,cant agrees to com~l~ with ~, o~,,~, ~, ~d~?~--, b~,~,~ ~od.,~o~,~, ~o? ~ ,,~,~o,,. ~~e cf applicant, or nam oration) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .................. ~ ........................................................................................... If applicant [~ o corporot~ signature oj~duly author[xed officer. (Name end title'of corporate officer) , 1. Location of land on which proposed wo~k will be dane.I Map No.: .......... Lot No.: ........................ Municipality 2. State existing use and occupancy of premises and iniended use and occupancy of proposed consfruction: a. E,~sting use and o~upanc~ ....//~.~.-r.~.....:. ................................................................................................. b. Intended use and occur:om:, ......~~.-~ .......................................................................................... o, Nature of wo~k (check which aoplicab[e: New Budding ................. Addit;on ................ Alteration ............. Re a~r Removal Demolition Otb p ................. ._ ...................... ................................... 4. Estimated Cost ..~.~C.~.0 ..................................... Fee .,..~..?.. ....................................................................... (to be paid on fCing this applicat~6n) 5. I.~ dwelling, number of dwelling umts ...... ~,~..~,.. ............. Number of dwelling units on each floor If garage, number of cars ...... ~...'T..,~,,~ .......................................................................................... ~ ...................... 6, If business, commercial or mi×ed occupancy, specify nature and extent of each type of use ............................ 7~ Dimensions of e):Jsting structures, Jf any: Fron~ ............................ Rear ................................Depth ................. Height ...................... Number a~ S~ories ................................................................................................................. Dimensions of sai'n~, structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Hsight ......................... Number of Si-eries ................................ 8. Dimensions of en~'irc new construction: Front ...... ~.,,~ .................... Rear ...~..,~.~...] .............. Depth ................. Height ...,/..~....'. ...... Number of Stories ...... ~ ............................................................................................... 9. Size of lot: Front ,.~.J~,,.,~.~. ...... T~er, lr ...... ~....~..,.~ .................. Depth ...,./.,,~...(..-,~. .............. 10. Date of Purchase ........................................................Name of Former Owner ....................................................... J 1. Zone or use district in which premises ore situated ..,. ,~,.. .......................................................................................... ~.;../_ ~--~, .~..,.,. phone No- .............,,-,--. No,m,~ of Architect .................. ,~ ,4'/-~~'"'~'""~r .................... Address ......................................... ~. _. Phone No .................... Nome of Contractor~,/~,~'-'-~.~~'v'../~ .~/",,Z~'.. ...... Address .~'..~.,:~.. Phone PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate oil set-back dimensions fram pro, party lines. Give ~treet t~nd block number or description according to deed, and show street names and indice'i'e ~hether fnterior or corner Jot. d~oses and says that he ......................... J.X..~;]~ .................................................... being duly sworn, the appdcant (Nome of individual signin~pplic~~- above named, He }s the ................. ~,.<..~.~.~J~,L~ .............................................................................................. (Contractor, agent, corporate officer, otc.) of safd owner or owners, and is duly ~uthorized to perform or have performed the said work and to make and file this application; that oil stmernents cont.;ined in this application are true to the best of his knowledge and belief; end tha~ the work will be performed in the manner set fo~h in the application filed therewith. Sworn to bef~ me this ~ ~ /' *' .... ' '~ blotor/ Public~[..~.~ . Counh, (Signature of applicant) ,OA~ ~tOOD