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Home My WebLink About8862-z I~RM NO. ~ TOWN OF. SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT CrHIS PERMIT Mu~T BE KEPT ON THE PREMISES UNTIL FULL C~PLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: Date ......................... J~ ....... :[6 ......... , 19...76 IP~M_ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWH CLERK'S OFFICE SOUTHOLD, N. Y. Disapproved a/c ..................................................... .. ~ .............................................. '/ " APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Th~s apphcation must be completely filled in by typewriter or in ink and submitted in triplicate to the Bui Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b Plot plan showing Iocahor~ of lot and of buddings on premises, relationship to adjoining premises or public stree areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which ~s part of this applica 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 issue a Building Permit to the applicant Such p: shall be kept on the premises available for inspection throughout the work. e No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occup, 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 Budding Zone Ordinance of the Town of Sou(hold, Suffolk County, New York, and other applicable Laws, Ordinanc: Regulations, for the construction of buildings, additions or alterations, ar for removal or demolition, as herein descri The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, an admit authorized inspectors on premises and in buildings for necessary inspections. ...... (S ig n~~ ~ ~f,~"~" ~';l~'~'~ii~i" ...... (Address of applicant) State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bull ................................................ ................................................................................................................... Name If apphcant ~s a corporate, signature of duly authorized officer. (Name and (,tie of corporate officer) Builder's bcense No ..................................................... Plumber's L,cense No ....... ../....~_.~...7. ...... ~ ................. Electrician's License No .... .~....~.,~....'t....~.. ................... Other Trade's L~cense No ............................................... 1 Location of land on which proposed work w,II be done. Map No: . ...r~.O'~.~J~...c!~...?.P...~ ...... Lot No ......... Slreet and Number .~~~...~ ........ /.Z~..~9..: ..... ~....~.~.~.~., ............................ Municipali~ 2 S~ate existing use and occupancy of premises and intended use and occupancy of proposed construction' a Exislting use and occupancy ................ ~ ................................................................................................ b Intended useandoccupancy ............. ~....~./..~.~... ............................................................................. 3. Nature of work (check which applicable): New Building ................ Addlban .................. Alteration ............. Repair ................. Removal .................. Demoht~ar, ................... Other Work .................................................. (Description) moted Cost ............. ................. Fee ?_ . ............ (to be prod on filing th~s 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 m~xed occupancy, specify nature and extent of each type of use ........................ 7. Dimensions of existing structures, if any: Front ...........~.....z ......... Rear ........... ~.~....~ .............. Depth ......~ ....... Height ........................ Number of Stories ............................................................................................................. Dm,enmons of same structure with alterations or additions: Front ......... .%. ....................... Rear ........................ Depth ............... ..'~... ............ Hmght .......~ .............. Number of Stories ...... 8. D,mensions of ant, re new construction: Front ......... ~.~..:.,..~.. ............ Rear ...~.....~..'.. J~pth .... ..~....Y...?. ...... Height .................... Number of Stories ......... ~....~..'?q!..~.& .............................................................................. 9 Size of lot. Front .........?.~7....:. ................................... Rear .,?..~?..~..~...;../.....s~....~ ................. Depth ...../...~T...:. ............ 10 Date of Purchase .........../~...(¢..~'.. ................................. Name of Former Owner ....~.../.~..~. ~.~....~)....e~..~.~-_~' .............. 1 1 Zone or use district in which premises are s~tuated ............................................................................................. 12 Does proposed construction violate any zoning law, ordinance or regulation: 13 Wdl lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes ( ) No 1 4. Name of Owner of premises C~'44¢z,~...t~..c~.T'~.C'J~ ..................... Address .~f..~..~..~..~.'2.~.. ........ Phone No ~ .~, ~,-¥/~,,.~,,~,j (. _~, ...................... Name of Architect .~.~t.C~r(k..~-/~/~.,.~...-S .......................... Address .~x~x~/~r~...~..~.. ....Phone No. ~..~.7..//../.~...~.. Name of Contractor Cb~.~,...~.~..gt.~.£..77. ........................ Address ..~.?....~..~....~.~...~.~ ..... Phone No. ,.~.~.t.:.~(./..~..... PLO]- DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fron property lines G~ve street and block number or description according to deed, and show street names and ind~cat~ whether inI'enor or corner lot STATE OF NEW YORK, [ ~ ~ COUNTY OF .... ~j~O~r, ........... ~ ~'~ ................ tl~t.~t~. J~.~-.~,.-~,C~£1~'~--~ ...................... being duly sworn, deposes and says that he is the opphcam ,(Name of individual signing contrac~ above named He ~s the ......................................................... ~-~' .................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the sam work and to make and this application; that all statements contained m this appl~cabon are true to the best of h~s knowledge and behef; ant thor the work wdl be performed m the manner set forth in the apphcation filed therewith. Sworn to before me this ...... · ].4~ ........ day of ....... ~J~.~',J~....}~_.~' ............... , 19..'7~... Notary Public, . .................................. ~,~O,],~ County ...... ~ ...................................................................................... ~'*' (Signature of applicant) ~ · r,/r /z ELJZABEI~"I ANN NEVILLE NOTARY PqP'lC. State nl N~w York No 52 ~l~SFSO Suf;olk County THE OFFSEfS OR DIMENSIONS SHOWN HEREON, FROM THE PROPERTY LINES TO THE STRUCTURES, ARE FOR A SPECIFIC PURPOSE AND USE, THERE' FORE THEY ARE NOT INTENDEO TO MONUMENT THE PROPERTY LINES OR TO GUIDE THE EREC- TION OF ~ ENCES, ADDITIOI~AL STRUCTURES, OR ANY o~,rHI~R IMPROVEMENT. OFFSETS ,1~ DIMENSIONS 1'O CONCRETE FOUNDATION LOT NUMBERS SHOWN THUS C i~'~ ' REFER TO THE MAP OF FILED I'.d,:~v' ~, t~ FILE No SCALE 1' = ~O' DATE · INDICATES I~TAKIr . INDICATES MONUMENT UNFI'Er'i ~TATES ~ANDARD OUTHOL. O TOWN OF ~OL)T~OLO SUFFOLK COUNTY, N. Y. coFa. uscr, mngham 516/261.1717 239.aL'* n ,r ,q TITLE NUMBER____,__ THE Of FSEIS OR DIMENSIONS SHOWN HEREON, FROM THE PROPERLY LINES TO THE STRUCTURES, ARE FOR A SPECIFIC PURPOSE AND USE, THERE FORE THEY ARE NOT INTENDED TO MONUMENT THE PROPERTY LINES OR TO GUIDE THE EREC' TION OF FI'NCES, ADDITIONAL STRUCTURES OR ANY OTHEtl IMPROVEMENT OFFSETS & DIMENSIONS TO CONCRETE FOUNDATION LOt NUMBERS SHOWN THUS REFER TO '~HE MAP OF FOR: J ,J :-: :.LL-~___ ..... SCALE 1 - 4~) D E · INDICATES 9TAKE · INDICATES MONUMENT UNITEO ~I~ATES STANDARD OF PROPERTY AT SOUTHOLO TOWN OF GOLJT~OL.D SUFFOLK COUNTY, N. Y. _ Fa. user, 516t261'1717 239 ~ t ' L 'ti