HomeMy WebLinkAbout7357-z FOI~M NO. ~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N~ Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
Ne 7357 Z
Date
Permission is hereby granted to: ~'
................................................
..... ~l,~.l~;~..~a ...................................................
LaUrel
to .e..~.e..~.~.~..~.~.~.$.~k~.~;~.s.;~.e..~.~:.~.~.$~.e.~.£.~..~.~~.~£~..~i~ & ~ea~ 2
at premises located at Ln~..;~(3 .......... ~tlr.~l...~ .........................................................................
............................................. ~....q~.o.~..D~.i~e .......... Laud. el ....................................................
pursuant to application dated ......................... .J.,.%~....~....,.2.~. ............ , 19.~...~...., and approved by the
Building Inspector.
Fee $...J~ 5;.*.QO. ........
Building Inspector
in ink~ and md=mi~ed in triptlo=~ fo the ~:
commenced before i~tonce of Butldir~ Pmmmit.
Builcl~ Permit ~o the applicant. Sueh permit
cs~nature of o~, ~i~,, if o ~ "
State whether applicant is armed, le~eee, o~enl-, o~d~itect, engineer, gener~ contractor, electrician, ~ ~ ~.
..... ~.~ .............................................................................................................. . ..........
. ~...~.~ ........... ~
~ of ~r of ~ .......... ~ ......................................................................
If~l~isa~~mof~~~.
(Name and tie& of c~ officer)
Builder's Ucenm No ....... : ............................................
Plumber's Licerme No ...... .~ .........................................
Electrician's License No .............................................
Other Trade's Lic4nse No ........................
]. Location of land on which praposed w~rk will b~ done.. ~Mop No.:~,_.~_.~.. ............ ~. .............. Lot No....-~...~,. ...............
Street and Numbm .~n~..,~....:~..~et~..~~..L./...~..~.~.....;
2. State existing use and ~ccupancy of premises and intended use and occupancy of prOl~ co~:
a. Exisiting use ond _,~'__--.~~~.~.~-..~~ ..............
b. IntemiKI use ond occupancy ...................................~ "....~ ~ ........................................................................
Nature of work (check which applicable): New BuJ'lding .................. Addition .................. Alteration ..................
Repair .................. Removal .................. D~molition..'....J ............. Other Work ~'~..~ ...............................
(Description)
4. Estimated Cost ............................................................ ~ee ..........................................................................................
(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 ....................................Pear ............................
Depth ................................ Height ............................ Number of Stories ................................
8. Dimensions of entire new construction' Front ........................... Rear ............................ Depth .~¢.~;~ ....
·
Height ..... .~Z',/~... .... Number of Stories ................................................ ~ ........................................................ ~ ............
9. Size of Iot'~Front ...... .~..~-~..~.. .................... Rear .....~..~.~.... ......................... Depth ....'~.'...'~.....~.... ............
10. ' ~Y'~'~ "'~ /~/~ ~ ~ Nome of F~armer Owner
Date of Purchase ...4/Z...,..~, .~.~,,7/..~.~'.~./.~'.~ .......... ........................................................
! 1. Zone or use district in which premiX'es are situated ................................................. ;~].~ .............. ..~ ...... )-~ ...........
12. Does proposed construction violate any zoning law, ordinance or regulation: ~?'.,~'..~'.~..~.~'~.~ .........
r e -- qo
13, Will lot be regraded . ................... -~7'. x/~//' ....... WilLexce>s fill be removed f~x/. ~.~' ~/~ .~°m premis p~: (~) ~ ( ) N
]4, N,ame of Owner of premises .' ..~..~'~....~.~..~..~ ........... Address~;~..~; Phone N0.
Name of Architect .............................................................. ~ Address ................................ Phone No .......................
Name of Contractor ............................................................ Address ................................ Phone No .......................
PLOT DIAGRAM
Locate 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
whether interior or corner lot,
STA'FE OF NEWxx~P,J~,/
OF~/.~'/.~'~'~~" '" being duly swam, deposes and says that he is the applicant
COUNTY
(Name of individual signing contracf)
above named.
He is the .................................................................................................................................................................................
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized ta perform ar have per~ormed the said work and to make and file
this application; that all statements contained in this application are true to the bes~ of his knowledge and belief; and
thor the work will be per~ormed in the manner set forth in the application filed therewith.
Sworn to before this
~ ~ 13~gnoture ~Hcon~/