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Home My WebLink About7432-z FOR~I NO. 2 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) N? 7432 Z Permission is hereby granted to: ...... .5,h~,]..v.e.y.....~,~..o.~ ....................... : .................. .................. ~'~.~o Jr,~o ¢.ue ........................................ to ..er.~c.~..~. ~i~talr~.~r~Ca~c a.s s~.)...~r~..~tand ................................................... at premises located at .N~.S...C~...~..~id.§o..Lar~ ........... · .......................................................... ................................................... .~tcha~ue.....l~ ~ ~ ........................................................................ pursuant to application dated ....................... ,[.iL~ .......... 23 ........ , 19..~.~.., and approved by the Building Inspector. Fee $$10~,, D~ ............ f ' ' Buildih~ Inspectort . BUILDMG DI~ARTMB4T ~om~,~ ....... .~..~ ....... , ~.ZT.. ,~,c~ ~o ............................... ..~ ....... 2" . ' ...... ~ ....................... *~,~ ~ .uu,~ .~,T a. This o~lication must ~ c~le~ly fill~ in ~ ~iter ,~.in i~ a~ s~mi~ in tripl~ ~ ~ Bui~i Ink,tar, wi~ 3 ~ of p~s, ~cum~ p~ pl~ ~ ~le. F~ ~ ~ ~h~le. b. Plot plan s~ing I~ation of lot a~ of buildi~s ~ premises, ~lat onship to ~joini~ premiss or~s, and givi~ ~ ~il~ d~ripti~ of I~ ofp~ must be drown ~ the diag~m which is c. The wo~ c~r~ ~ ~is a~licati~ may n~ be ~mme~ bef~e i~uance of Buildi~ Pe~it. d. U~n a~ol of ~is a~licati~, ~e Build~ Im~tor will i~ a Building Pe~it to shall ~ k~t ~ ~e p~i~ ~il~le ~r in~ th~h~t ~ ~ e. No building s~ll ~ ~c~i~ or u.d in ~ole or in pa~ for any pu~se ~er ~il a ~ific~ of ~cupanc~ sbell have ~en gmnt~ ~ the Buildi~ In--tar. ~PPLI~T ON IS HEREBY ~DE to the Buildin m n ' · · .............. g ~pa~ · t for ~e ~uance of a Build~ Pe~t pu~t ~ the ~e ~--' ....... ~, .. . . ~,~ or mr ~al or ~lltl~, as ~in ~r~d. ~p,~con[ agr~s m c~ply wire a. a~icaDm ~, ora ~, ~i ding c~, h~ c~e, admit QUthoriz~ in~to~ ~ premiss o~ In ~ildl~ ~r ~e~ i~tions. ................ (Signature of applica~i, ' i~i ........ or ~me, .................... ...... State whether applicant is owner, lessee, agent, amhitect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..................... __ . If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Map Np.: .................................... Lot No . Street and Number ...................~/~....~v. ...... .~....~....~.. .......... 2. 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 ...... ..~..rj~:~......~ .................... $ ....................................................... 9. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ................. RepaJr .................. Removal .................. Demolitior. .................... 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, speci.fy nature and extent of each b/pa 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 ..........~ .................. Dimensions of entire new construction: Front ........... .~. ...................... Rear ...... ~1[.....~.~. ......... Depth ....... ..~. ............. Height ......... ..~..~ ...... Number of Stories ...................................................................................................................... Size of lot: Front ........................................................ Rear .......................................... Depth ................................ Dote of Purchase ........................................................ 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. Will lot be regraded ........... ' ~/,~,~-D', -- 4~-~ ....r,~--.y?..Will e~ess fill be removed from premises: ( ) Yes ()No 14. Name of Owner of premises ...~.~-,~:~........'~.....~ ................. Address ................................ Phone No ....................... Nome 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 proper~y lines. Give street and block number or description according to d~d, and show street names and indicate whether interior or corner lot. 7 STATE OF NEV~.~ ~S.S cou."n' OF '~'X':~_~. j' .................. ......... being duly sworn, d ases and se;,s he,s the opp,can, above.named./ /~~ He is the ....~~ ...................................................................... J ................ -~ ~ontractor, ag~t, co~orate officer, etc.) of said owne~s~~~horized to perform or h~e performed the said work and to ~ke and file this application; t~t all statements contain~ in this application are tree to the best of his knowledge and belief; and that t~ work will ~ perform~the manner ~t fo~h in the application filed ther~ith. Sworn to ~fore me this ~ J ~ -- ................ ~.o~ o, ...... ~ ............... . ,~.2~ ~~ ~ ~ ~' ~ n /~ ...... ..]. ....................................... .o,~.u~,,~. ............... 4...4 ........ / ............ ~ ~ ........ ~ ~..~ ................ ~~~~A~Y pUBL C. S ' N~ , olk Cou~ No S2.,B22026: ~f~h 30 19~ ~emmlS~G~ ~xpire, " '