The URL can be used to link to this page

Home My WebLink About6690-z FO~M ~TO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMIS~S UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 6690 Z Permission is hereby granted to: .... ~t.~r..~..~.~.e~..,~.~t~ ........ at premises located at'~ ~ ] ~J~ · ~ezLw-b~,zao~ .............................. ....................................... ~/.&..~;~ ..~c~cl, ......... ~' ~et~.....R:,.~..,... ............................... : ....... pursuant to application dated ....................... ,.~..~..... J~..;~... , 19~,~..., and approved by the Building Inspector. Fee Sjt~.oZlO ............. FOI~M NO. 1 TOWN OF SOUTHOLD ~ BUILDING DEPARTMENT TOWN CLERK'S OFFICEi SOUTHOLD, N. Y. Approved ~'~/ ' · 1~ ........ Pemit No. Disapproved a/c ..... ~.~ .... .-~-...~-,~ ............................. ~.~-,,~ ................................. (Building Inspector) / Application No ................................. AP L,CAT,ON POR EUaD'NG E MJT Dote ' ........ INSTRUCTIONS a. This applicatiod must be completely filled in by typewriter or in ink and ~submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Pict plan, showing Iocatioh of lot and of buildings on premises, relationshi'p to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on diagram whi~ch is part of this application. c. The work covered by this applicati~)n may not be commenced before issuance of Building Permit. d. Upon app~0v~l of this application; the Building Inspector will issue a Buildin~ Permit to the applicant_Such permit,shall be kept on the premises available for inspection throughout the work. e, No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION l$ HEREBY MADE to the Building Department ~or the iss~an(~'of a: Building Permit pursuant to the Building Zone Ordinance of the Town of $outhold, Suffolk County, New York, and 9ther applicablei Laws, Ordin~r~des Er Regulatio~ns, for the construction of buildings, additions ~0r alterations, or for removal or demolition, as herein describ~d:!The applican~ agrees to comply with all applicable laws. ordinances building 6ode housing code, end regulations, and to admit authorized inspec1~or$ on premises and in buildings for necessary inspections. (Signature of applicant, 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 owner of premises ....~[l~;I¢...k~.....l~l,.,~..~'~t~,.~JJ..~T~.~ ............................................................. If applicant is a corporate, signature of duly authorized officer. iName and title of corporate officer) Builder's License No .......................................................... Plumber's License No~ ............................... E ectr c an s L~cer se No: ........................................ O her Trade s License No ................................................... 1. Location of land on which proposed work will be done. Map No......~..~. '~..8. ................................. Lot No...,~.~.....~...~..~. ..... Street and Number ....~..~J~cl ................................................. ~ ......................................... ..~.t~.~..~. ............ ~ ~wunimpanty 2, State existing use and occupancy of premises and intended use and ocdupancy of proposed construction: a. Existing use and occupancy ................................... ~..., ....... .~......;.,...,..; ...... ~....~,.~ ..................................................... b. Intended use and occupancy 3. I~l~ure'of work {check Which applicable): New Suilding ...................... '.' ~d~lition ...~ ............ Alteration ............... Repa~'l' ~.,.~.z .............. Removal ......................... Demolmon ........................ Other Work .................................... ( Descri pti on ) 30o0,oo 15,0o 4. Estimated Cost ............. ; ................................. Fee ............... [ ~;~ '1;'~ 'l~;i'~l' ~ ~' '~ili r; ~]' ~i;';l'l~ [i;;~i~ ~i ................................. 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 occuoancv, specify nature and exten, t of each type of use ..................................... · , ~ ~, J~0 ~'~; e th ..~..~.~ 7. Dimensions_~f~,5 ~st~ng structures, d any. Front .....................Rear ........................... D p ................................. Height ........................................................... Number of Stories .....~..~ .............................. · ' ' . ~ ear ..~.~.~..~. . . Dimensions of ~ame structure w~th alterations or add~tions. Front ....~.. ................... R ... ~ .......................... - _~ .3~ £~ . . He -hr ..2~. ~ Number of Stor es . .. uep[n .......................... u .................................. 8.. Dimensions of entire new construction: Front ......................... Rear ........ ' .................... Depth ................................. Height ...................................... ' ........... Number Of Stories ................................ ; ................... ? .................................... 9.-~ Size of lot: Front ..........[~'~6' .................. Rear .......................................... ..... n .... eo~t~;~o3,c~Depth~ove3.opalel3~ .................................................. (30..~... ............. 10. Date of Purchase ..................................... Name of Fu,..=, ~,w.=, ........................................ ~ ..................... ~.esi~en~ial i 1..Z~,ne or use district in which prem ses are situated ............................................................. ~ ........... ~ ............................ ~2. Does proposed constr~ction violate any zoning ~aw, ordinance or regulation: ..... ~Ag. ........... ................................. ~ .... ' ~0 13. Will lot be regraded ..............................Will excess fill be removed from premises: [ ] Yes [~ No 14. Name of Owner Of premises. ,.~...'..~..'.....~.....~.Z.~.'. ~.e.. ..I~...n33..~,~...p...o.l~....,,S,,,O.~g~.,.,,7.~5;a,~ ......... · (Address) . (Phone NO.) Name of Architect ................................................... ; ............................................................. ;....ii~.~.,l(l.~i ............... (Address) Name of Contrac~tor ........................................ , ................................................................................................... . (Address) (Phone No. PLOT DIAGRAM ' Locate clearly and distinctly all buildings, whether existing or proposed, and indicate alt Set-back dimensions from property lines. Give ~treet and block number or description according to deed, and show street names and indicate wheth- er interior ' lot. ~, STATE OF NEW YOR~ ) COUNTY OF ............. .'~.~7..~.,.~ ...................... ) ~ __ ~ _ ,.~{Narn~of indiviauat signing contractj He is the .............. z~~ ,~,,w~. ......... ~..~-.-.~.,...~ ...... ~'~ - { Contrad~or, agent, corporate officer, etc.} of said owner or owners, and is dulv authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are t{ue to the best~(6f~s~rklq~e'~ge and belief; and that thee work will be performed in the manner set forth in the application filed therewrt~ .......... ~ ~u ~ ~ ~,~ e-~ ~ t I No, 5z.u;~nn¥oa ~u..o,,, ~ da of ,~,.,.._~mrnissien E~p!~ree~,,ch 30, 19..~.~ . , .......................... · ....................... Notarv Pu blic.,~..~..,~....~..,~ L ~, ' ...~,...~ .~...(~o u nt¥ ....... ..~Z. . .,~. .~..~, ............... ~' '~" -"~-"~ ' '" ' ·; ......... . ..................................... ~ {Signature of appticantJ