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Home My WebLink About5948-z FOP*~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N* Y. BUILDING PERMIT r (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5948 Z Permission is hereby granted to: at premises located at pursuant to application date~ '"i*"*, . , and approved by the Building Inspe, ctor. , .................. '..: .......... Building In Examined .~...?:...~. .............. , 197....2Z'... FOI~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMEN1 TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No....~..~...¢...~..~ ............... INSTRUCTIONS a. This application must be completely filled in by tvpewriter or in mk and ~ubmitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot p~an to scale· Fei according to schedule. b. Pict plan showing location of lot and of buildings on premises, relationshi~ to adjoining premises or public streets or areas, an~ giving a detailed description of layout of property must be drawn on diagram whi(~h is part of this application. c. The work covered by this application may not be commenced before issuance ~f Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to ~he applicant. Such permit shall be kept on~ the premises available for inspection thro'ughout the wgrk: , t. e, No building shall be occupied'or used in Whole or in part for any purpose w~atever untd a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Departmen'~ for the issuar~c~ of a Building Permit pursuant to the Bud ng Zone Ordinance of the Town of SoL~thold Suffotk'CountV,'N~w York and other applicabie'~Laws, Ordinances ~r Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. ~rhe applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspec?rs on premises and in buildings for necessary inspections. IAddress o~ epplieant) State whether applicant is owner, lessee, agent,_~archite,?~t, engineer, geneial contractor, electrician, plumber or builde Name of owner of premises ........................................... ! ......................................................................... If applicant is a corporate, sionature of duly authorized officer. . i (N~lme and title of corporate officer) · n ' h re ' ne · ,~' 3/8Z 8- 1. Locat~o of land on whlc p p sed work will be do . Map No ...... .~.~/'.. ....... lot Nm ......................................... Street and Number ......... ,.O,.. .......... ff:.,~, .......................................................................... ~,~, ................................ Municipality 2, State existing use and occupancy of premises and intended use and occ0pancy of p~oposed construction: a. Existing use and occupancy ..................................... ;~:~ ....................................................................... - 'Nature of work (chock which a New Building ....................... Ad~on ...... ~ ......... AIterationq.?~..:.:~:. Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... (Description) 4. Estimated Cost .......... .~..q~..O..~...f~... .................... Fee ..../. .......................................................................................... (to be paid on filing 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. Dimensions of existing structures, if any: Front ........ .~..0. ........ Rear ............ .?...~. ......... Depth ....... .Z...~. ...................... Height ........................................................... Number of Stories .................. J. ......................................................... Dimensions of same structure with alterations or additions: Front ......... .~..~ ........... Rear .......... ?...~. ......................... Depth .............. ~..~. ......................... Height ................ ./...6.. .................... Number of Stories ...... /. ................................ 8. Dimensions of entire new construction: Front ........... /.~/. ......... Rear ....... ~.~/. ................ Depth ....... .Z.~.. ..................... Height ................................................. /~ Number of Stories ............... /. ......................................................................... 97 "Size of lot: Front ....: ....... ~..~. ...................... Rear ............ ~. ............................ Depth J~ ~' ............ Height .................................................... Number of Stories ...................................................................................... 10. Date of Purchase ..................................... Name of Former Owner ............................................................................ 11. Zone or use district in which premises are situated //~ 12. Does proposed construction violate"any zoning law, ordinance or regulation: ....... /...~. ............................................. 13. Will lot be regraded ......... ..~...~. ................. Will excess fill be removed from premises: [ ] Yes [~'1~10 14. Name of Owner of premises .....~..?..f,~.e....../'..//.././.~..C ............ ..~......~...~f;...~..~.~.~.~./...~.. ................................. , .............. (Address) (Phone No.) Name of Architect ...................................................................... i~i;~'~i .................................................................. (Phone No.) Name of Contractor .....~..~.%.?..).!../~S~....., .~...~,./.°/.,e.f...~...?~ ......... ,Z..,°.?...(.~...X,...}:..%....C-.~..?.' ............ Z~.. ,~...5.,.-.0.../.C .... (Address) (Phone No.) PLOT DIAGRAM :Locate cL,early and. distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from - proper~cy lines. Give stre'~t and block nu~nber or description according to deed, and show street names and indicate wheth- er interior or corner lot ~ /.~_ _l_.jb '-~ /~¢>- STATI: OF NEW Y(~K...~/ co .......... ......... ................ ,~ ............................................. being duly sworn, deposes and says that he is the applicant above named, ~f l~rnd of individual signing contract Ne is the ................................................................................................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this applicotion; that all statements contained in this application are true to the be~J~f~il~.k~dge aod belief; and that the work will be performed ih the manner ..... Notary public, Stale of New Yom set forth in the application flied the~.~with. No 52-0344963[ Suffolk County,~ ........... / ~C~ day of Commlss,on ExR,res~a'~ 30, ...............-- ......... Notary Pub i~f~Z.-~t~ ........ ~.........~..¢.......~unty ........................ ...~...~ .................Ir~..~ ......... r .................... ~,/' - ~- : (Signa~re of applicant)