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Home My WebLink About8078-z FOI~B~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING eERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ' NO* 8078 Z Date', ............................ Permission is hereby granted to: ..... .~..T:.~.~./,.:.~.:t ...... .e...~.~-.:~.~ ~..l~...~.- ............... ~.~.~..~.~..~..~ ............... .......... ~ · P' 7" ' ~ at premises located at ....... a .~Z'..j..~.L,J ........ j',~.~...,/.~ ....................................... ~-r ..h..~ ..c:. l..~ ..... pursuant to application dated ............................... .%~...U...~...~/~...../..~....., I~Z.., and approved by the Building Inspector. Fee $ ........................ Building Inspector INSTRUCTIONS o. This application must be completely filled in by typewriter oe in irg¢ and submitted in triplicate to the Building Inspector, with 3 sete of pkms, 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 ofpreperty must be drawn on the diagram which is part of this application. c. The work c.~.overed by this qpp~ication may not be commenced before issuance of Building Permit. d. Upon approval of this applJcat[or~, 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. APPLICATIC)~IS~ to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Orclj~nce of the Tow~ o-f euaut~, Suf~[k County, New ,Yo~k, and ,other pppl!cuble La~.., Ordi,nanc.,es or Regulations, for ~he construction of buildings, additions or alterdtlor~,, or mr-~mmova: or de .molition, as herein aescrmea. The applican.t ~lrees to comply with all applicable laws, ordinances, building code, houslng~l!xxJe, and regulations, and to admit authonze~ inspectors on premises and in buildings for necessary ir~ctions. of appllco~rlnbme, if a corporation) State whethert aPl~licant is owner, lessee, agent, architect, engineer, general contractor, eleCtricio, p, plumber or builder. 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 Trode's License No ............................................... 1. Location of land on which proposed work will be done. Mop No.: ........................ :.......~: ....... Lot ~ ..... :..~ ............... Street and Number ........... ~.....~.~. ........ ~..~..~../.~-~. .................................................................................... Municipality 2. State existing use and occupancy ~f pre~.e.s a-;~ intended use and ~ccupancy ~f prep~sed c~nstru~t~on:~ a. Exisiting use and occupancy ........ ~.t....~...~ .................................................................................... b Intended use and occupancy ................ ./. ~'~7' ~ ? ........................................ 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ................................................ . .... ~4:1;;~---~ (Description) 4. Estimated Cost ............................................................ 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 ............................................................................................................................................. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 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 ................................ Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ ~l. teight .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10~ Date of Purchase ..... ..~...~..'.~'...~ ....................................... Name of Former Owner ........................................................ ! 1. Zone or use district in which premises are situated ..................................................................................................... Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ Will lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes ( ) No Name of Owner of premises .................................................... Address. ................ ............ . .. Phone No. .............. .... . ... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor .................... ~_~_-,.~.. ~ --r-- ~-- -I- PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all dimensions from and indicate 12. 13. 14. property lines. Give street c~nd block number or description according to deed, and show street whether nterior or corner IOt. i STATE OF NEVV Y,~QRK.~.-./.- :.2 J~_c c. · COUNTY OF ..... .. · .'::~,.qJ~ ..I ...?..f. !.~l,,~'' /"'t ................... ~~...~.....~'~~ei~ ,du~ sworn, d~,~ and says t~t he is fhe applicam (Name of i~ivi~al signing c~tmc~ above name. He is the .......................................... ~ ............................................................................................................. (Contractor, agar, corporate offi~r, etc.) of ~id owner or owners, and is duly authorized to ~rform 0r have performed the ~id work and to ~ke 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 ~ performed in the manner set fo~h in the application filed therewith. .S..~.~.r..~t.~:.f..~r.: d~;tho;S ......... ~.~ .............. , 19.....~ ................... ....... .... ................................. , / ~o. 52-81258~, Suffolk Term ExDi~es March ~. CL E'At~V~'W A ~,'£N'IJ£ ~I'V'£$ '~'