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Home My WebLink About8210-z FOR~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. S JLO Z Date ....................... ~pt.-.-~ ............. , 19..55. Permission is hereby granted to: ~o~md.v~e~...Re~ta-u~an~.--.~aek.,.Lev~Lt~-. ............... t~rt.h.,ti6 ............ 8'~'e~nl~oz~ ............ ~o B~.~& ..n~...£~e ~ ~'...~,~.. ~d~., ~ ......................................................................................... at premises located at ....lJJfi..l~Ol;'.'lGll...Ro~,& ..................................................................................... ................................................................. g~en~c~z'.t, ......... ~,~, ....................................................... pursuant to application doted .......................... ~ep~ ......'i~ ........ 19~..., and approved by the Building Inspector. Fee $..1.,~.~..0...0. ........... FOF~[ ~0. ! BUILDIHG DEPARTMENT ~4~''''~ /~"~ ~ TOWH CLERK'S OFFICE ~ ~UTHOLD, N, Y. ~proved ........................................, 19.Z~.?Permit No...~.~..¢. ................ Disapproved a/c ...... ~-..~......~~ ........................ APPLICATION FOR BUILDING PERMIT Application No. C~//~) ~-- 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 Iocotior~ of lot and of buildings on premises, relationship to odibining premises or public streets o~ areas, and giving a detailed description of layout ofproperty must be drown 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 o 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 hove been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the i~suance of o Building Permit pursuant to the Building Zone Ordinance of the Town of Southo!d, 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 ir~ buildings for necessary inspections. ,Tack Levin (Signature of applicant, or name, if a corporation) ~ S mxbhold ........................ : ....... ............................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. O~,fl'ie r Name of owner of premises ..{~.qu~}.i'~.Xe.;'r...~le.~.i~.r.{s}i ......... ~i{:.Pk.L.%~$~}...~.~31.o.P. .................................................... If applicant is a corporate, signature of duly authorized officer. ~ (Name and title of corporate officer) Builder's License No .......... .0.~{~.-.e.~ ............................... Plumber's License No ................................................. Electrician's License No ....... .~..:...~.,.p.~.~.l.~ ................... Other Trade's License No ............................................... Location of land on which proposed work will be done. Map No.: ........... ..~.~. ....................... Lot No. xx Street and Number ........... ~/..~{~...b.~.~}...~.e/A~.....(.g.~J~Y..) ........... ~ ........................................................................ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy . .business buiidj,.n.~ ....... .-.....r.~.~.t...a..u..r..~7..~. .......................................... b. Intended use and occupancy ......... .s.~{/.r!.e....~.{,,i.~:...a..c.~.~.i..i...~.~.,o.,,n. ....... ~.~.~.~..~..~....~.~..o.z.p}.~?. ................................. ,3. Nature of work (check which applicable): New Building,. ................. Addition ....%.~..%. ........ Alteration ................ R~pai~' .................. Removal .................. DemoIitior, .................... Other Work ..... ~ .o..O...e. ~.~ .o...~.~. ..................... .... (Description) 4~ Estimme¢, C;~¢r .;~.~ .......... ,- .r .......................... ~r ..F.ee ..... .1.~,~.O0... ~ .................................................................. ' (to be pain oh fi 'lng th s appli~d~r 86) 5. f dwelhng, number of dwelling units ....... .0. ................... Number of dwefling 6nits an each fl~,,9~ F;",~',7,'.',~': ............... :,. lif,,,[jcir~Lqgft; r~,qmb~r of qars ............................................................................................................................................. 6. if business, commercial or mixed occupancy, specify nature and extent of each type of use .....~..~...s.~.z..e..s.'.,.s. ..... ~.' Dir~n] ohs of existing structures, if any: Front .................... ........ Rea~ . .............; ................. Depth .................... Flel~iht ......... ~ .............. Number of Stories ................... ,..,..,,,...¢~:~.:=~.~ ........ :r~: ....... : ................................................... Bi~e~siens of some str~lctMre with alt~rcl~iqns or qddifjoD~s; Erpnt ......... ~ ............. ~e~9~' ,', I~p~l,".,.~ ........... ; ........ , ........ Height ..........................,,Number 9f ~f~r, ie.s ..:..: ........ ?.; ......... :....:, ,: 8. bin~erlsioa$ of entire new f:¢~$trqgtif~n: Eront ........... :8. ............ :.. ....... R99r ..... .8. ................... ,..De, pti? ~.O,.'..:.t.. ............ Height .,; .......... ~ ......Number ef Stoeielt .............. ,.,.l!..r-*..:...t.f,*t,! ................. : .......................... i ............... :: ................ 9. SI~!'Uf lot: Front ........................................................ Beer ........ ¢.,,., ............................ D~e~th ................................ 10, Dote bf .J~urehose ......................................., ......... ,..., N.gm¢ of F9rmer (~wner ......... :'st ...... t"~'.,'.~ ............ . ................ 1 1. J~orte s~)r use district in which premises are situated ...~..-..~.~ ....................................................................................... J'2. '.J)oes.pr~pose~, constrL~¢tion ¥iolclt~ any zqning Jaw¢ ordimg, nce o(' regulgtion: ..... ;(2.Q ...... : ,,,,, ................................. l~? X/VIII Io~,be,,e§r~ded . ............. Z],P ......... Will excess fill be ~'emoved from,premis~; ( ) ye~, ( ) N9 1 ~! Nam~ 0~ ~vneF of premises ..~O~Zt&'vTJ,.o,~.,[...i-~).S.~&1%c',8.~. ~dress ....G.~ZS.g,.ZL~OZ'..~ ....... Phone No Name of Arch tact Address ................................Phone No ....................... " t%Sn~a o~f Co,t/actor ...... .O.?.~,.~.e.,~. .......................................... Address ................................Phone Ne..., .................... !,, r~,:,, ,, ,, PLOT DIAGRAM "~ from Locate clearly and distinctly all buildings, whether existing ar ¢lrc~$ed, ~nd indl~qtt~ gJl ~]e, trJc~zJf, ~[in~,ensions' .... property lines. Gw,e street and block number or description according to deed, and show street names and indicate whether *nterlor or corner at. ' ,: : STATE OF NEW YOR!<, /¢, COUNTY OF ...~.g,~'~,..q%[f, ............ fo'~ Jack Levin ................................................................................................ being duly sworn, deposes and says that he is the applicam (Name of individual signing contract) (]6~ve ~nbm~;cl',,"' x' : He is the ....................................Z~:p.~}=.2e%o2...o.~..hus.&zze&s ....................................................................................... .... (Contractor, agent, corporate officer, et~.) : ,at said awgei or owners and is duly authorized to perform or have performed the said work and to make 'and file ~s app~Jcahon; that ali statements contained in this application are true to the best of his knowledge and belief; and t ',tk,~r the w~rk, wi]l be perf¢rmed in the manner set fo~h in the application filed therewith. Sworn to befor~ me this ,' ~ ' , ............ ................ ........... ...... ............ :... ""' '" ""'" ~ ~~.w¥- ~-- ~,'.f(. ' ' ~ - ~' -- ~% (Signa~ of applicant) NOTARY PUBLIC, Sh~te o~ New Yor~ ' No. ~2-4522526" Sur;oJ~ Coun~/ Commission Exp[re~ March 30, 19..~~