The URL can be used to link to this page

Home My WebLink About8498-z FOltM NO. ~ TOwN O~ %THORO BUiLDI~4G :be~RYJ~£i~lT ToWN cL~R~ S OFFICE SOUT~LD, N~ Y. BUILDING PERMIT (THIS PERMI'T MuST BE KEPT oN TEIE PREMISES UNTIL FULL COMPLETIO~ OI~ THE WORK AUTHORIZED) Examined .............. Approved ........................................ FOI~/[ NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 19 ........Permit No .................................... Application No...~..~.~..~../~.....~... .............. Disapproved a/c ....... ~z...: .~.: .~... ......................... ~ .............................. ~/-~-~- ~ '(Building Inspector/ APPLICATION FOR BUILDING PERMIT ................. INSTRUCTIONS o. This application must be completely filled in by typewriter o~ in ink 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 or areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application. 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 permit 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 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 Southotd, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. 'The applicant agrees to comply with oil applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for neopssory inspections) (Signature ~,or name, if a corporah'~on) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. == :;' =:; :;' ::::::: ................................................................................. If applicant is a corporate, ~,ig~ature of duly authorized off'c . (Name and title of corporate officer) Builder's License No ....... b~.: ......................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... ~ ,7' 1. Location of land on which pro, posed,v~rk wjII be done. Map No.;~ ..~-.~ ....... ./rr2v.~ ................... 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 ........ ~.~: ........... ~.~ ............................................................................ b. Intended use and occupancy ...................... ~ ................. ~ ........................................................................... 3. Nature of work (check which applicable): New Building, ....icC............. Addition .................. Alteration ............... Repair .................. Remova~ .................. Demolition .................... Other Work ................................................... ,~ ,~- ~ (Description) (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 ...... ~....~...f. ............. Depth ....~.0..../. ........... Height ...... ~ .......... Number of Stories ..................................................................................................................... 10. Dote of Purchase ........................................................ Name of Former Owner ........................................................ 1 1. Zone or use district in which premises are situated ............ ,1~... .................................................................................. 12. Does proposed construction violate any zoning [aw, ordinance or regulation: ....................................................... 13. Will lathe regraded. ........ /~.0 ........... :nWillexce~ fill be removed from premises: ( )Yes (I~NO Name of Architect ........ (/. ............................................... Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate dearly and distinctly ail buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and black number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, ~c c COUNTY OF ................................ ................................................................................................ being duly sworn, deposes and says thqt he is the applicam (Name of individual signing contract) above named. He is the ................................................................................................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, end is duly authorized to perform or have performed the said work and to make and file this application; that ail 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. Swam to before me this /...~...~.. /k J"/? /,. ........ .day ~of ...,.,..,z.....!..-~.,~.~.....~ ........... , /'/ (Signature or applicant) MARTIN SUTGR // NOTARY PUBLI(~, Sfa~'e of New YolrJ~ / / ~)uallfied In Suffolk C~eut~ty Ne. 62-39G492S ~*' ',~'.":,"~ E~pirel Ma~h 31, 1977