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Home My WebLink About6008-z FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE pP, EMISES~ UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: ~,, ~ ~ ~. .w...'......:::......:.....:;..)(..~.....~..-..m .......... ~......, .......... to ~ .~.....~-; ......... .¢. ................................................................. ..~' ...... ............. at premises located at ....,:..~ ....... ;...~. ......... .v ....... ~. ................. .......... ~ ............................................... pursuant to .application doted ........................ -¥ .............. -'--"~'-", '" ".' Building Inspector. Fee $,~:?i-~..,-.~.-. ......... FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. Application No, (°.,,.(.:.!,.'.d!.~i,~.,. .......... APPLICATION FOR BUILDING PERMIT Dote ......... J~J~.. ~.~t~ ................... , 19.~2 ....... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and ,submitted in triplicate to the Building inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and gw~ng a detailed description of layout of property must be drawn on dlagram whi6h ~s part of this application. c. The work covered by this applicanon may not be commenced before issuance Of Building Permit. d. Upon approval of this apphcation, the Budding Inspector will issue a Building Permit to the applicant, Such permit shall be kept on the premises available for inspection thrqug,hout the work e. No building sha~l be occupied or used in whole or in part for any purpose w~atever until a Certificate of Occupancy shall have been granted by the Budding Inspector. APPLICATION iS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Soutlnold, Suffolk County, New York, and other applicable[Laws, Ordinances or Regulations, for the construction of buddings, additions or alterations, or for removal or demolition, as hereto described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and m buddings for necessary inspections. (Signature of applidant, or name, if a corporation) ., ......... .... ......... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of ow,er of premises ....... ~,!..z~...~..~.~,~_~;..~.n.~r. ........................................... ........................................................ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate ofhcer) 1. Location of land on which proposed work will be done. Map No.: ..................................................... Lot No ............. Street and Number ]~or~h ]]~y~e~ 8o~.~ ~.ou,~,t~ll~ [~',y, ......... : Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ............................................................ ........................................................................ b. Intended use and occupancy ............. ..2~J...~?.?.?.....~..?.~.%.~ ..................................................................................... 3. Nature of work (check which applicable): New Building ....................... Addition ..................... AIteration...~.~.. Repair ............. - ............ Removal ......................... Demolition ........................ Other Work ~.f,~.~..~;l,],... (Description) 4. Estimated Cost .....~...0..0.... ................................. Fee ................................................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ....~.llfl ....... 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 ...51~..x..2~.... Rear .....~.~c.2/~ ........ Depth ....... 2/4, ...................... Height ........................................................... Number of Stories ............. ~,..~. ......................................................... Dimensions of same structure with alterations or additions: Front ..... .~ ......... Rear .......... -~ .............................. Depth ............................................. Height ................. ~ ....................... Number of Stories ..... _-7 ................................ 8. Dimensions of entire new construction: Front ...~,0.,~.e. .............. Rear ............................ Depth ................................. Height ................................................. Number of Stories ......................................................................................... 105e 105· 1 · 9. Size of lot: Front ...................................... Rear .......................................... Depth ..... ~.~. ........... : ............................. 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: ........... 1~1} ............................................. 13. Will lot be regraded ..............~ae .............. Will excess fill be removed from premises: [ ] Yes [ ] No 14. Name of Owner of premises ............... (Address) (Phone No.) Name of Architect ..................................................................................................................................................... (Ad re s) ( hone No.) Name of Contractor ...~..?.~..~.~......~....~.~ .~...~.?.~ ................ ~.~.e...ee'..u....~.~.~.~..a..~..,..3I..'..¥., .............. ~..2~...~.0.~} ....................... (Address) (Phone No.) PLOT DIAGRAM I.ocate 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 wheth- er interior or corner lot. STATE OF Ni=~W YORK, COUNTY OF ...?.~.~..~....~ ...... ~..¢,~, ......................... ) - ............ ~......~.~.?,~;.......~;.:_.,,??~.~.,; .......................... :.....~ .............. being duly sworn, deposes and says that he is the applicant alcove named. i~varne o% mai~tauat signing contract) ' ' He ~s the ................................ 4:...e,.?~..,&.~.~.~.~,....~.~.., ......................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to ~r~orm or have performed the said work and to make and file this application; that all statements contained in this application are true to the best oj[~j~ and belief; and that the work will be performed in the manner set forlh in the application filed therewith. N°~'7 I~t~bl~c. Slofo ~ New ..................... ................ · .. c'"'"'""~ _ - - ' ' ~amre o[applicant)~