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HomeMy WebLinkAbout7599-z FOE~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK's OFFICE SOUTHOLD, Nm. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°. 7599 Z Permission is hereby granted to: at premises located at . 7 ~70 /tl, L/q~/z- /~ ~ ~Vt.-- ................................................................................ /: .................................. pursuant to application dated ....................................................... , 19. and approved by the Building Inspector. Fee $..../...~.- ............... Building Inspector APPLI~.d~,TIOfl FOR BUILDING PERMIT~.~'~'~' J~'~.,.~'- ~ ~ ...................... ......................... , 19.,..~ ..... IN~U~S . This a~lic~im m~ ~ c~pletely fill~ in ~ ~ewriter or in i~ a~ ~miff~ in tr~l~ ~ ~ Bui~i~[ ~or, with 3 ~ of P~S, ~cumte plm plan ~ ~le. Fa ~o~i~ to ~h~ule. ~ b. Plot plan ~ing I~ation of~ a~ of buildin~ ~ premiss, relationship to ~joini~ pmmi~ or ~llc ~ o~ ~ areas, and givi~ a detail~ ~r~ti~ of I~ ~p~ must ~ drown ~ the di~mm ~ich is ~ of ~s ~liCati~. J c. ~e wo~ c~er~ by ~ a~lication m~ ~ ~ commenc~ before issuance of BUild~ Pe~ff. d. U~ ~al of ~is a~lication, ~e Buildi~ Im~tor will issue a Buildi~ Pe~it to ~e ~l~am. S~h ~it~ shall ~ k~t ~ the pr~i~ ~ail~le ~r in~ti~ ~h~ ~ ~rk. e. No ~ildi~ shall ~ ~cupi~ or u~ in ~ole or in ~ ~r any pu~se ~m~er until a Ce~ifi~ of ~cu~y shall have ~en gmnt~ ~ the Building Ink,tar. , ~LI~TI~N .IS HERE~Y ~DE to the Building De~ment for the i~uance of a Build~ Pe~it pu~nt ~ ~e ~e annlicant a~r~s ~ -~-~- -..:*~ -" _[~,~_~s or ~s~ ~.tor m~? or ~iti~, m ~ ~ri~. admit~th_.:_~~ ,_~_~,,~,x ,,.. ?. u~,?a~m.~, o?lna~, ~.ai~ c~, n~i~ c~, ~ ~1~, a~ ~ ~.~ ,~Jo~ ~ p~ml~s ~ I~ DUI~I~ ~ ~ J~ti~s. (Signature of applicant, or name, if a corporation) l/lit ,"~"'~ I ~*"t' t '~-~t ~'~ //~. (Address of applicant) t / ? . ~ State whether applicant is owner, lessee, agent, archit~t, engineer, general contractor, electrlcion, plumber or builder. Name of owner of premises '~ / ' / ~ : ' "~ If applicant is a corporate, signature of duly authoriz~t officer. (Name and title of corporate officer) Builder's License No ........................ ~; ........................... Plumber's License No ................. ~...~.. Electrician's License No ............ ~..~.. ....... Other Trade's License No ............................................... 1. Location of land on which proposed work will be clone. Map No.: Lot No. / Street and Number Municipality' 2. State existing use and occupancy of premises and intended use and occupancy of praposed construction: a. Exisiting use and occupancy ................................, b. Intended use and occupancy ...................................................................... ~ ................................. ..................... 3. Nature of work (check which applicable): New Building. ................. Addition ................. Repair .................. Removal .................. Demolition .................... Other Wo~ .................................................. C/f/', ;[ / / '.-- .~ / ~ ~- (Description) 4. Estimated Cost ............................................................ 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 ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ............................... Height ............................ Nu~nl~r of Stories ................................ 8. Dimensions of entire new construction: Front ........... ~ ........................ Rear ............................ Depth ........................ Height .................... Number of St~i. ej~ ..................................................................................................................... 9, Size of lot: Front .................................... ;~:..~.it ........... P, ear .......................................... 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, orciinance or regulation: ........................................................ 13. Wil lot be regraded .............?'r ......... ~t,~ixU excess fill be removed from p~,mises:x( ) Yes ( ~i No 14. Name of Owner of premises .................................................... Address ................... : ............ Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Nam~ of Contractor ........................................................... Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions from property lines. Give street and block number or descriptio~ according to deed, and show street names and indicate whether interior or corner lot. '_.STATE OF NEW ~OR~., COUNTY OF.... :,~-..~. ....... ". ~ ~/' 't ~ ~ ' sworn, MJeC~ and that he is the applicant ......................................... ~ ..................................................... being duly says (Nome Of ind~idual signing contract) above named.. / ,., ~ / /%., He 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 application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to hero/e, me this ........................ day of "t: ........... ~','"": ................... ~, 19.;.~ .... Notary Public, .............................. ~ ......... ~ ....... ....-~T~ounty J~!DITH T. B©KEN (Signature of applicant)