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Home My WebLink About7115-z FORi~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT' TOWN CLERK'S OFFICE SOUTHOLD, N.. Y. BUILDING PERMIT :(THIS PERMIT MUST BE KEPT ON THE PREMISE~ CO, MPLETION OF THE WORK AUTHORIZED) UNTIL FULL N? Z Permission is hereby granted to: ...... ~.~...~b~..~ ................................ ...................... ~r~ ................... : ................. at premises located at .....]~P,~.,~q~m~.e)..~....A.g.~....~....~,.~.9.g~...~.o.~i,. ....................................................... Ore e,n.~!ort g.~Z. ~: .................................................. pursuant to application dated ................... .}.~..~ ....... J..~: ............ i...., 19.,.~'.!'k, and approved by the Building Inspector. Fee $..1. ~.:.(~'.0, ........... ..................... Building Inspector ~0~ NO. ! TOWN OF SOUTHOLDi BUILDING DEPARTMEI~T TOWN CLERK'S OFFICE $OUTHOLD, N. Y. Examined ...... .~.G~... ............ , Approved ~ ~ ~ ~ Permit No ....................... ~ ............. Applicotion Ho ................................. m Disapproved a/c ............................................................................................ ....................................................................... (Building Inspecto7 , APPLICATION FOR BUIL~ING PERMIT INSTRUCTIONS o. This application must be completely filled in by typewriter o~ in link and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets o~ and giving a detailed description of layout ofproperty must be drawnfon the diagram which is part of this application. areas, c. The work covered by this application may not be commenced befo~'e issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue o Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the wo!k. e. No building shall be occupied or used in whole or in part for any pu. rpose whatever until a Certificate of Occupancy shall hove 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 Southoid, Suffolk County, New'York, and other applicable Lows, Ordinances or Regulations, for the construction of buildings, additions or alterations, orjfor removal or demolition, os herein described. The applicant agrees to comply with ail applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in, buildings for necessary ihspections. ;' ........ ~ PP , , P ......... (Address of opplicont) / State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...~/~,~.....~.~.~.467~.. .......................... ........................................................................... ......... ~'"'('~l~l~"and title of c~r~¥'afe"~'~fi'c¥'i ......... Builder's License No ..................................................... Plumber's License No ................................................. ~ Electrician's License No ............................................. ~ Other Trade's License No ............................................... ~ 1. Location of land on wh'j~n propose/Ti work wi~J~be__f~one, Map No,: ........................................ ~ot No ............... J"'""*' t Street and Number ...~'~.'~f,/~..~...~.~..~ ....................... ............................... .-~.7~-~ ,¢,~,~.~.~...., .......' : NYunicipa li~/ 2. State existing use and occupancy of premises gpd i~tended use and occupancy of proposed construction: b. Intended use and occupancy ................................................................. '..i:.~..~.'.¥..~.f~:*~ ..................................... '.3. Nature of work (check which applicable): New Building .................. Addition .................. '~'J-_ ~AIt~oti°n .............. ,... Repair .................. Removal .................. Demolition .................... Other Work ....... ~~ ....................... (D,~"~/r iption) 4. Estimated Cost ........................... i..-Z..~.'~.......d~..~ .......... 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 ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................... X Size of lot: Front ........ ~..?.~..Z.~..~..~. ........................ Rear ...... J~._.~. ............................ Depth ................................ 10. Date 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. WiN lot be regraded' . ........................... Will excess fill be removed from premises: ( } Yes ( ) No 14. Name of Owner of premises ~/t~,~'..~.~.....~..~.~..: ................ Address~.~.~Z..~'~'~...~.~.~hone No. Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate ail 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 ~ot. ST^'rE OF NEW COUNTY OF ...............................//7/g ............................................................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) ~bove named. He is the ................................................................................................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to p~rf.orm or have performed the said work and to make and file this application; that all statements contained in this application are true fo the best of his knowledge and belief; and tha~ the work will be performed in the manner set forth in the application filed therewith. Sworn to beige me this ............ . No, 52-0344963 Suffolk Count~