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Home My WebLink About7651-z FO~I~ NO. ~ 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) 7651 Z Permission is hereby granted to: ..B~Z~.s Lc. ua.. ~.,,.. Ku.t~ ..................................... ,\ ......... · ~;.....tn~ee~....l~.wl ........................... ................ ~te~p~te~. ...... ~1';~'; ......................... ~o B~14..e~',..&dg~.t~..on..~L s.t,~u~g..~rzl& ............................................................... : ..... at premises located at ..~.~l~..~/...~flTdl ................................................................................... ............................................... 7~u~ .......... ~L,.~.. ........................................... ~ .................................... pursuant to application dated ......................~..~.~.......~Q ................. , 19.~..~....~ and approved by the Building Inspector. Fee $.$ 0,,,0~0 ....... , .... Buildin~ Inspector/ APPLICATION FOR B~JILDING PE~JvUT INSTRUCTIONS a. This .?.pp~cation must be completely filled in by typewriter ac in ink and submitted in triplicate to the Buildin~, inspector, w,m ,s ~ of plans, accurate plat plan to ac:ale. Fee according to ~:hedule. -~ b. Plot plan sho?ing location of lot and of buildings on premises, relationship to adjoining premises or public streets o~ areas, arm giving a aetailed description of layout ofproperty must be drawn on the diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. ~ d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit~ shall be kept on the premises available for impectia~ throughout the work. e. No building shall be occupied or used in whole or in port .for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. · APPLICATION IS HEREBY/V~DE to the Buddl rtmen ' ~ · . ng Depa t for the issuance of a Building Permit pu_ _r_r_r_r_r_r_r_r_~ to the-q; Th a .......... ng?: .... s, or or removal' or demolition, cie herein described. ~ e. p~pu,~.~nr[zae~gr~nS~totc~omp~y~w~ni.a[,_ ~al~j,_.c_ab~l_e.,~, ordinances, bull.ding ..c~de, hou~ng code, and ragulatiam, and toG: admit a_t .......... _._ .........,..-...aea ~rm m ouJm~ng~ mr necessary inspections. ~ ...... ........ (Add~ of mppliconf) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................................. .................................... Name of owner of premises ...... ~.~.J~.~.~.~........~........~...2~....~..~,~ ........................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. r, Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's Licer*~ae No ............................................... Location of land an which praposed work will be done. Map No.: ........................................ Lot No. ........................ Street and Number .......... ~...~.~.~.~.l.~....~.~..~.....~.~.~/.~.~...ut..~..~.~ ......... J.~../2.~.~..~.r.a~.:..~. ............................... State existing use and occupancy of premises and intended use and occu~-~y of p~ ~: a. Exisiting u~ and occuper~ ...... ~(~1'~.~1~' ........................................................................ b. Intended use and ocCUlXIncy ............. ~.~.~4~'~... ....................................................................................... 3. Nature of work (check which apphcable):e~ew Eudd,ng.. ................. AGG;i;ur, ........ ~. ........ Alteration ................. Repair .................. Removal .................. Demolition.....~ .............. Other Work ................................................ . .... (Description) 4. Estimated Cost ........ ~....~.~.~./~...~.' ............................... Fee ....... .~.../..~. ......................... ~ ...................................... ? (to be paid on filing this application) 5. If dwelling, number of dwelling units ......... ~ ............. J.Number of dwelling units On each floor ............................ If garage, number of cars ............a...~...~... .......................... ~ ......................................................................................... 6. If business, commercial or mixed occupancy, specify nature and eXtent of each type of use ....'... ...................... 7. Dimensions of existing structures, if any: Front ..i.~..'. ................... Rear ...... /..~...~. ................. Depth ..~., .............. Height ....... .[3 ............. Number of Stories ........ Z~JI/A~ ................................................................................................ Dimerisions of same structure with alterations or additions: Front ........ ,/~.. ....................... Rear ~.~..~ .................... Depth .....~,~..~. ................... Height .....,/.~..~. ................. Number of Stories ...~.?I,Z'...~.. ................... 8. Dimensions of entire new construction: Front ...J'~.~ ..........................Rear ..~/...~..~ .................... Depth ...~....~..~. .............. Height ...../....~.~ .......... Number of Stories ..... ~..,.~.,,~..-~, ...................................................................................................... 9. Size of lot: Front .......... ~..~..~.~.'~'' .................................. Rear ..... ..~...~..~ ............................. Depth ...~.....O~....t. .................. 10. Date of PurChase ..~..~....~.~/~ ........ ~'.~...7...~..,.; ............... Name of Former Owner'.~../....~...~.z-..~.~../~....~....~.8'.....~ 11. Zone or use district in which premises are situated ....~.~.[;.~,~.~.T.J.,~.L. ................................................................ ;.. 12. Does proposed construction violate any zoning law, ordinance or regulation: ~.~ .................................................. 13. Will lot be regraded .......... ~ ............. Will excess fill be removed f~o~l~&mmises; ( )_Ye~ ( ) No 14. Name of Owner'of Premises ..~,~'../,/~'..v~'.".~..:../~..V...~...Z:..... ~J :~ ~'/'~ ~7 Name Of Architect ...... .~. ....... ..~..~..~..L,./. ................................... Address ................................ Phone No ....................... [Name of Contractor A/~L'~' Address ................................ Phone No. ...................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or Proposed, and in~dicate all set-back dimensi~>ns from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YOFLK_ -- COUNTY OF ....... t~'~..~'~',,. ~ ~ ~.., .~.. ...... ......................... ~...~./~,~[~,~.l~..,,~...~...~.~..~.~......Z~-f.......,..being duly sworn, deposes and says tbot he is the applicom (Name of individual Signing contractO~ above named. He is the ................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or haVe performed tl~ 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 Jn the application filed the~. Swam ~;t~,lljll~f... ore me this .......... .......... ....... , ....... Nora ry Public, ~.~e~.~ ...~....~...l~..~a. Count''' '~~ ' ............ _____ ~--~' .......... : ............ ~j mkI~ J~~__.~, ~la~ll~ ~.' ' [ (Signature of applicant)~