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Home My WebLink About7296-z TOWN O~ SOUTSOL~ i TOWN GLERK'S OFFIGE SOUTHOLD, N~. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7296 Z Permission is hereby granted to: ~ oh.ri. ~..~,~h.e.r ~n~...,~.o.~.~r.~.s..,o.~..A.A.~,~.....~.qrr i s ......... ~.~..u...~g...~o.~.~. .............................. .................. Mat~l;uck to .erect and'main.t..a..~3..r.q~r....P..:.~..:.;~.~.;~.c..e..Q~3 .t~.~ ~.rg.B.~:~.~.tJ,~,~ .~ ;']~. ~..~. fe~ace on go~ris prop. ~ft high ', et prem~e~ 'oeoted et S../..S.'. ~U..~'.a Ao...a..a.. ................................................................ Mattituek N.Y. ................................................................. ~-~ ............... ,, ...................................................... ~.. pursuent to ~ppli¢~tion doted ................... .~..~..~...O. ....... ,~ ....... {......, ]9~..1~.....;, end epproved by the Building Inspector. ,?.?..0.......: ...... A~PLICATION I:OR BUILDING PERMIT ~:~ ~,~ Date ................................................ , 19 ..... INSTRUCTIONS a. This application must be completely filled in by typewriter or in link end submitted in triplicate to the Buildln§~,~ Inspector, with 3 sets of plans, accurate plot plan to scale. Foe occordinglto schedule. b. Plot plan showing location of lot and of buildings an premises, relat{onship to adioining premises or public streets or areas, end giving a detailed descripiion of layout ofproperty must be drown!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 issueia Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the wo~k. e. No building shal~ be occupied or used in whole or in part for any pu?pose whatever until a 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 Sou~hold, Suffolk County, NewiYork, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or Ilar removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary i~spections ~-, ~, , ............... /j (S~gnotu~e of applicant, or name, if a corporation) ~(~ .......,,..z.-m..~.:.; ............. ., .................... /..)..~.~ ........................... · , - _#_. ~ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises/~...~..~..:.. ~.~-..~..~.~..?.C.....)~r/~:~...~......~..~.~ ~ ................................................................. // .'/ If applicant is a corporate,U~ignature of duly authorized~fficer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... ~ ]. Location of lond on which p~posed, work will be do_ne.. Mop No.: ....?.~..;...~.,.-] ...................Lot No .................... Street and Number ~,~'......f.~.;, ............. ~.-z~....~..~.....~..-~.k~...~ .................................................... 2.State existing use and occupancy of premises and in,~ended use and occupancy of proposed construction: a. Exisiting use and occupancy ..~.....~.~..~.,~.,'?...~ ........... ; ......... i ......................................................................... Nature of work (check which applicable): New Building .................. Addition .................. 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 .................~.....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 ................................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ D~th ........................ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ............... ::: .............. 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 1 1. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ ~3. Will lot be regraded ............................ Will excess fill be remov~ from premises: ( ) Yes ( ) No 14. Name of Owner of premises .................................................... Address ................................ Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of.Contractor ............................................................ Address ................................ Phone No ....................... ~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing proposed, and indic te all set-~ck dimensions from proper~ lines. Glve street and block number or description a4cording to deed, and ~how street names and indicate whether interior o~corner lot. ,'~ ~ . STATE OF NEW~ ~/ lc ~ COUNTY OF ~/~:f.C~..... f~'~ ................. .~ ........................................................................... being duly sworn, deposes and says that he is the applicam (Name of individual 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 fo~h in the application filed therewith. Swam to befgm me this ....... ........................................ ~ (Signature of applicant)