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Home My WebLink About7161-z FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISE6 UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 7161 Z Permission is hereby granted to: ~or...~te~...~ardw~e...~c ...................... . ...~:~. ~.~..~ ~.~ .~.ck. ..................................... : ................. to..e..~..e..9..t...~d..~..~.~..~.~.....~.~.....tt.~.~.e..~: ........................... ~ ........................................................ .,~/S Pike Street at premises located ar ................................................................... k ........................................................ Mattituek N.Y. pursuant to application dated ............................ ...~,,~.,,.~.-,...i ..... 19~..~,'....,', and approved by the Building Inspector. Fee $1 ~'.00 · ....................... Building Inspector FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMEN~ TOWN CLERK'S OFFICE! SOUTHOLD, N. Y. Approved ........... ~.!.~.... .............. ~:..., 19~.:Z Permit Disapproved a/c ............. ~.~ ......................... ~':""~/&"':"~,'-'~'~,~';i-/~-!' (Building Inspector)/-~; .......................... APPLICATION FOR BUILDING P~RMIT Dote ...... ...... o. This application must be completely filled in by typewriter or' in i~k and submitted in triplicate to the Buildin~l hl Inspector, with 3 set~ of plans, accurate plot plan to scale. Fee according ~o schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets al P' areas, and giving a detailed description of layout ofproperty must be drown .bn the diagram which is part of this application. ) c. The work covered by this application may not be commenced befor~ issuance of Building Permit. g5 2 d. Upon approval of this application, the Building Inspector will issue g Building Permit to the applicant. Such perm-~t )~ 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 pu(pose whatever until o Certificate of Occupancy shall have been granted by the Building 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 Southotd, Suffolk County, New ~ork, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, build(ng code, housing code, and regulations, and to admit authorized inspectors on premises and in. buildings for necessary inspections. (Si~Jnatu~e of applicant, or name, if a corporation) (Address of ~pplicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. n. - owner of premises ...... :..~....cm.X~.......~.......~z:..~"~ ....................................................................... Name of If applicant is a corporate, signature of d01y authorized officer. .............. ~r~e' ' ~ r~' '~: '~r '~" '~ice r" '")' ........ Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... Loca,~on of land on which proposed work wdl be done, Map No ..........................................Lot No ................. . ........ Street ond Number ........ ~ '7. ........................................................ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a, Exisiting use and occupancy ........................'~ .............. ; .......................................................................... b. Intended use and occupancy ......................... lwhether 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work ~ ,~...~.~.T......,~..~.~J.~,I~-f).L.~.....F...E~...~..~.. z_~ (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 ............................Number of Stories ................................ B. Dimensions of entire new construction: Front .................................... ~ear ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ............ Z,~..~../. ................................. Rear .............[..~..g..J. .................. Depth ......... ~ ..................... 10. Date of Purchase ........... ~4.~./.~ .........................., ~w -- ~Name of Former Owner ..... .~.~..~.~.~__ ........................ 11, Zone or use district in which premises are situated ...."...t~..,~......~.....~L~.~ ............................................... ]2. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded . ........................... Will excess fill be removed from premises: ( ) Yes ~) No of Owner of premises ..,fl..,.(~.~.~ ...................... Address ~.~(~.~ ..... Phone No. 14. Name Name of Architect .............................................................. Addre~ ................................ Phone No ...................... Name of Contractor ............................................................ Address ................................ Phone No ...................... PLOT DIAG~M Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-~ck dimensions from property lines. Give street and block number or description according to de~, and show street names and indicate interior or corner lot. STATE OF NEV~YORK,, , tcc - COUhl-['Y OF ~...~...~..~'..-.O.~..L~, ........ ......... L~.~.~....~.,.....(~.~.¢.~.....~.~ ............... being duly sworn, deposes and says that he is the applicant (Namb of individual/signing contracf) above named. He is the 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 fo~h in the application filed therewith. Sworn to before me this ........ ....... of .......... ............ , MA~IN SUT~ ~uaJlfled in Suffolk ,No. 62.3904925 --/ Ai",~-'~OYED AS ~,iOTED FEE: il ~bf 1, BEFORE BACKFILLING FOUNDA- TION CE S~ART FRAMING 2, BEFORE COVERING PIPELINE 3, FINAL WHEN JOB COMPLETED NOT RESPONSIBLE FOR DESIGN OR ~ ,r"r"'z/7q- ko -o [ q rt -'7,_ ....... ,_T, ................ .._.?, ...................... .... "---I