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Home My WebLink About8725-zBUILDING DERMIT CrHIS PERM T MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF ~I'HE WORK AUTHORIZED) Permission is hereby grar)ted ~o: pursuant to application ' dated JU'iy: !~ :: 19 76 and'pp ' the Y ......... ; .................... . ............. ...~ ...... ,...., a__roved b_ Building Inspector. Fee $.,,1.,~.;.~.0. .......... ~OEM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFI¢~ SOUTHOLD, N. Y. (Building Inspector) ~ APPLICATION FOR BUILDING PERMIT App,cotion .... INSTRUCTIONS o. This application must be completely filled in by typewriter or, 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 n whole or in part for any purpose whatever until a Certificate of Occuponcyf/g shall hove been granted by the Building Inspector. APPLICATION S 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 appllcabie Laws, Ordinances or Ragu ations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regu orions, and to admit authorized inspectors on premises and in, buildings for necessary inspections. ............ .T. NTN...P..0i~EL .F~,N D~E.. C .Q, .,... t~C ....................... ,.. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..................... ~on~.ag~o~'. ................................................................................................................................................... Nome of owner of premises .~r.~.,...~lct~moz'...D.,,..Z(~.~.on ................................................................................................ 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 ............................................... Location of land on which proposed work will be done. Mop No.: ........................................ Lot No ........................ Street and Number ....6b...g.o...~a~.or~.Z)z'...,...a~.ba~.~.,...~,...¥......~.:Lg..~.~ ................................... : .............. Municipality State existing use and occupancy of premises and in~ended use and occupancy of proposed construction: a. Exisiting use and occupancy .............................. ',..O...~.~..-..~....~..~..]:.~....~?..]:..]:.J:..D:~ .................................................. b. Intended use and occupancy ................................ .O...D,..~...-..~.~.],~....C].~.~.~ .................................................. 3. Nature of work (check which applicable): New Building'. ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ...~.e...n..q.~..n.~ ................................ (Description) 4. Estimated Cost ........ - ^~ --~.~?..~.?..0..? ................................... Fee ..... ~.1..~.....0..0. ....................................................................... (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 ........................ I-leight .................... Number of Stories ..................................................................................................................... 9. Size of lot: Front ......... 2.]-.~.~ ...................................... Rear ........... ;~.0.0..~. ...................... 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. Will lot be regraded . ........................... Will excess fill be removed from p. ret~ises: ( ,).Yes ( ) No u lvla~ on 14. Name of Owner of premises Ele~b':zom..D.,..~a.aQn ............. Address ~t.~o~og.~s.~....k~' Phone No..~ ]&..~.....~. ..... Name 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 frorn property lines. Give street, and block number or description according to deed, and show street names and indicate whether nterior or corner lot. STATE OF NEW YORK, COUNTY OF ....S.~££olk ........... ~'~ .......... ~.,...~..~.~.~.i~.Q~S .......................................................... being d,uly sworn, deposes and says that he is the applicant (Name of individual signi6g i:ontracf) above named. He is the ...... 0. DD.I:~'.~t~.tDZ". ................................................................................................................................................... (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 oil statements contained in this application are true to the best of his knowledge and belief; and thor the work will be performed in the manner set forth in the application filed th,~rewit/~ .................... Notary Public,. ....................... ~.... County ~~ ........................ NOTARY PUBLIC, State of New No. 52.8125~50, Suffolk Term [:xpires M,~rch 30, 19~