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Home My WebLink About10094-z FOF~M 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) N? 1009~1 Z Permission is hereby granted to: ~ ....... ~~..z.........~'.~.~z~....~. ...... .4~...~.~...X..~.-.. ........ ...~:..........~.~.c.~....~..~,,.....~_7.,. ~t~ ....~2~... ~ ~.~... ::..:.: ........ ~:..~::~:..: ........... ~.: ........ :.~.:: ....................... ............ ~ ........... ~ ............................................................................ ~. .................. INSTRUCTIONS a. This applJcotlan must be completely filled in by typewriter ac in ink and submitted in triplicate to the Building inspector, with 3 set~ a~ plans, accurcrte pl~t. plan to ~e. Fee ~cco~ing,to schedule.. . . . - . ~". -~; . '-; _- b Plat plan sh~Mg I~atlan o~ tot ~nd of buildMgs an pram sos, ~JaNansh~p to adjomtng premises or public stage's'or ' · .......... " ..... u-t ~e dr~n an ~he di~-rom which is pa~ of th~s apphcation. ~ ~e work c~ered by this ~pplic~ion m~y not be c~mmenced be~are issuance of Building P~rmit. =' <-. ~.-~ -: ,_'-- d. Upan~ppr~l o{ ~is ~p~l~cafion, ~e BuildJm~ Inspector will i~ue ¢ 8uiJ~Mg Permit to the applicant. Such permit e. No building shall be ~cup~ed ar used in whale or [n p~ far :ny pu~ase whatever until a Ce~ifica~e of Occupancy hall h~e been gr~nt~ by the ~uildlng lmp~or. .... ' . APPLICATION IS HEREBY ~DE ~ the Building Depa~me~ for the i~uance of a Buiiding Permit pursu?t to the iuilding Zone Ordinance af the Town of SouthaJd, Suffalk CaunW, New York, and other applicable Laws, Ordnances or regulations, far the con~ion o~ buildJngf[ cddiNans ar ¢:tar~ans, ar Far removal or demolition, as herein described. the ~ppl[ccnt agrees to comply with ¢11 applicable l~s, ardin¢nces, buildMg c~e, housing c~e, and regulations, and to ~dmit authorized inspecto~ an ~remJses and in buildings Far n~ess~ inspections.. ' - ~e~e~ ~pphc~nL or ~me, ~f a co~oratlon) ~ ..... ~ddress of oppffcant} tare whether applicant is owner, lessee, agent, architect, engineer, general. . controcteG electrician, plumber or budder, ~ ~e.~ ........ - ......................................................................................................................... ' ................................................................................. q~me of awner of p~mlses ...... .~ ...... -- ----. ~ . jf cppllccnt is ~ co~o~te,' sight, re of duly ~uthorizad off[cot. (N~me and title of ¢omo~te officer) Builder's Lic~se No ........... ~..~.~ ........................... Plumber's License No ................................................. Electnc~ans License No ............................................. Other Trade's License No ............................................... Location ef land an which proposed work will be dan~-. Map NaA ........................................ Lot No ........................ 5rre~-t and Number ....~.~..0. ...... /~.:....~...c~....~.¢~.; ............ Munlcipali~ ,n..n,-ea use and occupency at: proposed construction: fitate existing use end occupanCy o~c premises and ' '~ 4 . a. E.xislting use and occupancy ...... t....'~4~ .......... * .............. ::'~-~ ....................... '~.~' ....................................... _ g,, p. ,--- F .e. ~.4.~. ...-; .......... ~.~/..g4~..47~ ......... : .......................... b. Intended use amd occupancy ....................................... 3. N~ture of w~rk ' ~" '~' "' (Descr;p~;on) (to be paid on filing this ~ppl cation} 5. If dwelling, number of dwe~ing units ' . Number af dweiling units on each flor ........................ if garage, ~:~mber of ~rs ........................................................................................................................... 6. If bus~ess, enamor:iai or mlx~ accup:ncy, specifi/ r~:~ure and ex:e~t of each t)?~e oF use 7. Dimensions oFexistlng structureS, if any: Fran~ ........................... ~eor · ............................... Depth .................... DimenS~¢r,s o~ same s~ructure with ~ffef¢t o~ or ~d .H:r,S Fror~ ................................... Rear ........................ Depth ................................ Height ' ..N,un,ber of S~ories ................................ Dimensi:n~ oF andre new constructlar,: F~ant ................................. Rear ............................ D~th .................... . N~nte o[ Former ~wner ] 1. Zone or use district ir, which premises are situ~ted 'r. ~ .............................................. [2. Da~ proposed ccnstruction violate any zonin~ Iow, ordinc:ce or tabulation: .................................... 13. Will le~ be regr~ded ...... ~.C..~ ................ VZill excess fill be removed fron~ premises: b~)) Yes ' Address ......................... ; ...... Phone No N~me af contractor .......................................................... Address ........... ..................... Phon~ No ~LOT DIAGRAM ~c~ta clearly and dlstln¢Iy all bu Idin~s, whether existing ~ p~aposed,~n~ indicate o1~ set. ok $rm~¢~ lines. Give street mhd black number or de$cria:on mc.oroing ~o ae~, and show stree~ names and ind~ ~hetner i~teriar or comer Io~. ' ~'..,UN'~ ,.~F ............ being duly sworn, d .... e~ and s~ys thc, t he is the cpp ...... ................................................ ..... ..~9~[~n f cd therewith. ~ the w,:rk will ~e per¢or] ~d in the mcnner ..... .