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Home My WebLink About7118-z l~OIL~I NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT ! TOWN CLERK'S OFFICE' SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISE~ UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 71~8 Z Permission is hereby granted to: ~o ..../~d.~.~:/.. ,¢,/. .......... . .-:~.,~p~;,oc~ ...~o.~..c.~.~57~.,rz.~...=~z.~z~. .. ....... ~..z~.......zc~.~ ~o.//4 ...... **~r..,~***~z~.~ .......... i ............ .............. ~ ................................. */ ..... at premises located at .":~.~.~..~.~.~.7.~...-7.~::2-Z,C.L~-..~'-'~-~2.....~-...'=~..~'~,/./~..~ ............................ ...-......~c~..~..~.../..7~...~.,~.......-.. ......... ; ......................................................... pursuon¥ to application dated .X:'~'~..-~-..,,~.'~,~'~.-....../.,~-..*......, 19~.....~., and approved by the Building Inspector. Building Inspector FO~M lqO. TOWN OF SOUTHOLD BUILDING DEPARTMENI~ TOWN CLERK'S OFFICE~ SOUTHOLD, N. Y. ~r~ ......................................... 19 Per~ ~ ......................... Disapproved a/c .................................... Application No. 7 / INSTRUCTIONS a. This application must be completely filled in by typewriter oX in ihk and submitted in triplicate to the Building Inspector, with 3 set~ 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 areas, and giving a detailed description of layout ofproperty must be drawn (~n the diagram which is part of this application. c. The work covered by this application may not be commenced befor~ issuance of Building Permit· d. Upon approval of this application, the Building Inspector will issue .a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the world. e. No building shall be occupied or used in whole or in part for any pur~)ose 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 $outhold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, os herein described· The applicant agrees to comply with all applicable laws, ordinances, buildJpg code, housing code, and regulations, and to admit authorized inspectors on premises and in, buildings for necessary inspections. (S'g a re of applicant, or name if a cbrporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, gener0l contractor, electrician, plumber or builder, ............... ............................. Name of owner of premises .....I,~.!.l.l.!.~t.(..~......l'.5...L~.~.~...Fl_.(~l(~ ..................... ~ ......................................................................... 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 No.: ........................................ Lot No ......................... Street and Number ,,- , · , Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ...J..~.~J'~.~ ................................. ......................................................................... b. Intended use and occupancy ....j~.~(~ .~.'()~1 ....... .)~..~J.:~..;,l~.~ ....... ~.. .................................................... propert whether Nature of work (check which applicable): New Building ....,~....,. ....... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................... Other Work .................................................... (Description) 4. Estimated Cost ......... ,~...~....~'...LJ ............................... 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 end 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 .;.mT.. ...................... ,t~Number of Stories ................................., / /__ 8. Dimensions of entire new construction: Front ....~.C~. ........................Rear ..... .~..~." .............. Depth ..J~D.~ .............. Height .I..~.,...~..t.c:~.. Number of Stories ../.. ........................................... ~ ..................................................................... t I 9. Size of lot: Front ....... ~.O. ..................................... Rear ,..~.~1~). .......................... Depth ...~)..~...0. ................. 10. Date of Purchase .......... Name of Former Owner 11. Zone or use district in which premises ore situated ..................................................................................................... 12. Does proposed construction violate any zoning Iow, ordinance or regulation: .J..~.~. ............................................... 13. Will lot be regraded ...~.~) ............... Will excess fill be removed from premises: ( ) Yes (X) No 14. Name of Owner of premises ..~.;J/.J~m..,..:.J~.~..~U.~./~.(to/. ..... Address/.~.).ffT/Z.~'.T~..'9~.ig/..~)/,.... Phone No. Name of Architect ..... ..(~..~.~....~ ............................................. Address ................................ Phone No ....................... Name of Contractor ....~.J:~.~.....0...~..tR.~},~: ............................ Address ....~..~...1~.. ............... Phone No..~.J:3..!..~..~ ....... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from and show street names and indicate lines. Give street and block number or description accordina to deed, :,terior or corner Io, t /b.~ t~¢,~.~, f~¢,~ ~. ~ul~ I ! STATE OF NEW,Y.~?I~I~/,,..z/~ .~ .,~' ~S S OUNT · ................................................................................................. being duly sworn~ deposes and soys that ho is the opplic~n~ (Nome of individu~ signing controcf) 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. Sworn to b~for~ me this /~. ~ .......... ~ - JUDITH T BOI(EN (Signature ot applicant) Nota~ Pubhc, 51cJ]a al Now ~or~ No. 52-0344963 Suffolk Coun~~ Commission Expires March 30,