HomeMy WebLinkAbout7315-z Application No....?..~../..~.=. ...........
Examined ..~ .......... ~ ...................... 19 ........
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..... ...........
· ' (Building Inspdctor)
APPLICATION FOR BUILDING
.... . .. ,.st.ucrlO.$
a. This opplicatian must ~
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b. ~'P~'~~~d ~ildi~s
~, ~ ~vi~Q ~ J~ d ~ dp~ must ~ d~ ~ h di~mm ~h ~ ~R d thb ~l~im..
d. U~ ~ ~~,
e. ~J~ ~ ~~
APPLICATION IS ~Y MADE to ~ :Building_ Department for the i. _~mce of a B~ld~ng Pmmlt pur~,mnt to the
Building Zone O~i~ of l~e To~n Of Southo~, Suffolk County, New Yon~ ond ofher a~i~ble Lows, Ordinonc~ of_4
R.egulotlo~, for the ~ion of b~#diflg~, oddltior~ or olteratian~, or for removal or ~litian, a~ herein de~ribed.~/
aamit aumo~zecl ir~to~ on prermees ~ in I~Jamos Mr necessary inlpe~tmns.
//7/4/ (Adclmss of applicant)
State whether applicant is owner, Im~e, agent, amhitect, engineer, general contractor, electrician, plumber or builder.
~ of o,,~, of ~.mi~ ...,,~6~..~.,~./~,....,~..A,(~/,#".~Z.. ......................................................................................
If applicant is a cotporu~e, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's LiGense No .....................................................
Plumber's Lieense No .................. : ..............................
Electrician's License No .............................................
Other Trade's Liceme No ...............................................
1. Location of land o~ which pmp~ed WOrk will be done. Map No.: ........................................ Lot No .........................
Street and Number ~e...~~m~l~.~.~..~..~.~ ...........................................
Municlpall~
2. State existing use and occupancy of premises and intended use and occupancy of peala~ed construction:
a. Exisiting use and occupancy ....... ~~~ ......................................................... ~ ...................................
b. Intended use and occupancy ..... ~'~J~,~JlP~jJ..~.....~....~l~.~... .....................................................................
Nature of work (check which apl~ble):~ New Building ..... ...~... ....... Addi . .................Alteration ...............
Repair .................. Removal .................. Demolition .................... Other Work ................................................ ....~
(Description)
~ ~, ~.__~ ~_.o Fee
4. Estimated Cost ..... ~.~.~ ...................................................................................................................................
(to be paid on filing this application)
5. If dwelHng, number of dwelling units ............................ Number of dwelling units on each floor ............................
If garage, number of ~rs ........ ~..~....~...~.~ ...........................................................................
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................
of xi ti g o y: ........ O pth .........
Height ...... ~..~.~.. Nu~er 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 ...~..~..~ .............. Depth ....~.~ .............
Height ...~ ........... Number of Stories / ....................................................
9. Size of lot: Front .......... .~,.~.~ ............................ Rear ....... ~.~,...~ .................. Depth ~.~...~ .....
10. Date of Purchase ..~..~.m.K~.~. ....... Name of Former Owner ...~~ .........................
11. Zone or use district in which premises are situated ....... ~~ ............................................................
12. Does proposed construction violate any zoning law, ordinance or regulation:
13. ~ill lot be regraded . ....... ~ ............ Will excess fill be removed from premises: ( ) Yes ( ) No
14. Nome of Owner of premises .~..~..~~.. 2~ ~
Address ~,..~~.~ Phone No.~c~
Name of Architect .............................................................. A~re~ ................................ 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 ~imensions 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 Y~RK/'/./~.,:,
COUNTY OF
....................... ' .......................................................................... being duly sworn, deposes and soys that he is the opplicom
(Name of individual signing contracf)
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 befor~ me this ,-~ , /
........ of
~' t~gnarure ~t applicanT)
JUDITH T. BOKEN