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Home My WebLink About8003-z FOBM NO. 2 TOWN OF $OU'THOLD BUILDING DEPARTMEHT TOWN CLERK'S OFFICE SOUTH*OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 8003 Z Permission is hereby granted to: . ?.~.~y... ~:~..a..n.,¢.~...~ ....................................... ........... .~.a...q .~.9.~y... ~v..~ ............ . ,~. ~.~.$.~.u..~.k. ........ ~.~.~.a..~.~L.~.r?.~..t.?..~.~.s.~.y..~..~.~.a.~.g.~..~.~ ................................................ at premises located at .....~.../..~.....~..a..~.~.°..?.Z...A...~..e. .................................................................................... Mat t *.~uck N .Y. pursuant to application dated ............................. ~.~......t.~. ........ , 1J9..~.~.., ~nd approved by the Building Inspector. Fee $..,1..0.,..0g.. ......... Building Inspector FO~M lqO. 1 TO~N OP $OUT~O~D BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ......................................... 19 ........ Approved ........................................ , 19 ........ Permit No ..................................... Disapproved a/c ............................................................................................ Application No ................................. (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ................................................ , 19 ............ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink 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 o~ 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 $outhold, Suffolk County, New York, and other applicable Laws, Ordinances or Re~Jlations, 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 regulations, and to admit authorized inspectors on premises and in, buildings for necessary inspections. (Signotur/~ of applicant, or name, i~ a corporation) ....... / (Address of applicant) / State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. owner of premises ...... '/~'~'"" "~'"~'i~ ................................................................... Name of 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~.~ . . -- ~z--__pr°p°sed war,viii be done. Map No.: ........................................ Lot No ......................... Street and Number ..... ~...~.....~......~.;~ .~...' ..¢'~-~'/-- -- ........ ~ ........... ~.~ ........ '~"-' --.. ,.~'~'""/~""~/~": ..... / Municipa~iry 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 eccupanc¥ ........................................................................... 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ............... Repair .................. Removal .................. Demolition .................... Other Work ................................................ ..~ 4. Estimated Co~.....~ ................................................... CO E) Fee ..... L' .................................................................................. r0 ~ (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 ............................ "el ht /") j~'~j~'*/~ "umb r of Stories J I-I g ""7" .................. ixl e .......... .~. .................................................................................................... Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ................... , ................ Rear ............................ Depth ........................ kJeight .................... Number of Stories ..................................................................................................................... 9. Size of Jot: Front ....................................................... .7~/ . ~ .f Rear ......................................... Depth ................................ 10. Date of Purchase ...~R.I..../....~../..1..~..... .................. Name of Former Owner 11. Zone or use district in which premises are situated ..................................................................................................... ]2. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded . ........................... Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises/.L'~.~...J'.../~'~'~.....~..~.. Address ................................ Phon~ 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 ell 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 lot. OF ......... ......................... ~..~ ........................................................... being duly sworn, deposes and says that he is the' applicanl (Nam(of individual ~g~ng contract) ............................. ............................................................... of s~id owner or owners, ond is duly outhorized to per{otto or hove performed tho s~id work ~nd to m. ko end file this applicmion; that oll statements contoined in this o~plic~tion ore true to tho host of his knowlod~o ond belie~ thor tho wor~ w~l~ bo porformo~ ~n the mon~or set fortB in the opplicotion filod therowith. ~otory Public, . ............. ~..~ .C C~un~ ................................... Om atu applicant)