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Home My WebLink About4777-z FO~M NO. 2 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? 4777 Z Permission is hereby granted to: .............. ~...;~e~enete~ .................................. ..................... ~g.].~...~ .................................. ................ ~t~.J.t~uc~ ........................ : ................ to ......... Bu~,~ ct ..n~..a~.~ ~j,.. (.~t;~.~) ...~u~:t.~ ~ ..................................................... at premises located at .................. [~t~'~.~"'])~;~'~' ................. ......................................................... ................................................................ F~a~-~.~,~;-uek ......... ~,~'*' ....................................................... pursuant to application doted ............................ ~y .......... ~.....;...., 19..l~,e., and approved by the Building Inspector. Fee $'"~)e ........... Building Inspector Approved ........................................ , 19 ........ Permit No ............................ ~N OF ~UTHoLD ~ ~/Z~-- ~ BUILDING DEPARTMENT ~~ TOWN CLERK'S OFFICE ~ ....... a. This application must be completely filled In by typewriter or In ink ,nd submitted In duplicate to the Inspector. b. Plot plan showing location of lot and of buildings on premises0 re at onship to adjoining premises or PUblic streets or areas, and giving a detailed description of layout, of property must be drawn an th. diagram which Is part of thle application. c. The work covered by this application may not be commenced before issuance of Building Permit.'. d. Upon approval of this apallcotlon, 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 Walk. .. 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 Build ng Department for the issuance of a Building Permit pureuant to the.~ Building Zone Ordinance of the Town of Southo d, Suffolk County, New York, end other applicable Lawl, Ordinances or{ Regulations, for the construction of buildings, additions or a terotl~ns, or for rentoval ar demolition, as herein d#crlbed. The applicant agrees '0 comply with all applicable laws, ordinan~: building ~le, haullng~ode, and regulations. ...... ~,'~1,::: .-. ~_"' "; 'r "~;,"~ .~*~" ~ ........ ': ............................... ~:~gnature er pppjlcant., or nl~me, It a aatp~mtlon) ................... i'X~i~i.;,~'~"~D~.t'"i ..... ~' ..................... State whether applicant Is owner, lessee, agent, architect, engin#r~ general contractor, electrician, plumber ar builder. (Name and title 'of corporate officer) , 1. Locatlonoflandonwhlch ro osdwark, bedonStreet gj3~ ?_,uumber ........ .~~ / oo Mu.,c,pe,,,., ...... 2. State existing.use and occupancy of premlsel and Intended use and occupancy of proposed construction: a. Existing use and occupancy ........ ~;~ ................................ b ....· .......· .................7 ........'""'7" ........... 3. Nature of work (check which applicable): New Building ......../~. ........ Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ............. ,...~. ........................................ Fee .......................................................................................... (to be paid on fi!lng this application) 5. If dwelling, number of dwelling units ....... ~ ...... Number of dwelling units on each flOOr ............................ If garage, number of cars ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ~... 7. Dement. ions of existing s~ructures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ............. ~ ................. 8. D mens OhS of ent re new construction' Front .................. Rear ........ Height .................... Number of Stories ......... ~ ....... : ....................................................................................... 9. Size of lot: Front ........ .......... Rear ........ ............. Depth ...... ~..~...~....'~.. ........ 10. Date of Purchase ........................................................ NqLm~e~of,,Eormer Owner ........................................................ 11. Zone or use d str ct in which premises are situated ......... .~.~. i..~./. .................................................................... 12. Does proposed construction violate any ~lav~ ordinance or regulatlo~t~...._, ....... ~ ................................... 13. Name of Owner of premises ...i.~...........~...,~resl ...... .............................. Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ........... ,,~.~ ............... Address ............................................ Phone No ..................... Locate clearly and distinctly oll buildings, ~v~ether existing or proposed, and(indicate all ~eJd~ack dimensions fram property lines. Give street and block number or~sArli~'~n ,according to deed[ and shg~v-ttgeet names and ndcate whether interior or corner lot. .................................~~~.~......~...[.~....~:~....g ........ 5el~g ~uly Iwom, ~oles ~n~ toy~ t~t h~ Il the oppll~nt (Name of~ndl~dual signing application) ~ ~ , ~_~. above named. He s the ............. ~ ........ [~ ..................... ':; ....................................................... (Contmc~r, ag~t, co~omte officer, e~.) of said owner or owners, and Is duly authorized to pedorm or ha~ ped~ed the said work and ~ ~ke ~d file this application; that all statements contained In this applicatl, am tree-to ~e best of his ~wl~ge a~ ~lief; and that the work will be performed in the manner ~t fo~h In the ar Icatl~ fll~ therein. Swam to before me this ~ ~ .................................... ... ~ da of ....... :~.~ ....... 'o~0 ...... N~a~ Public ... Coun~ ~ant) ~ EUZAB~H ANN ~EVt~E ~-' NOTARY pUBLIC, State of ~w York N0, 52-8125850, Suffolk ~erm ~pir~ March ~, ~9~