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Home My WebLink About9787-z FOE~ ~0. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMtT MUST BE KEPT ON THE P'REMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 9787 Z Permission is hereby granted to: at premises located et ............... (~,t,:..~.../,,. Ii V ff t') (~ C ~ pursuant to application doted ~(/~1 l: ~' ~1~ and approved by the Building Inspector. Fee $...~.~.~..........~ Building Inspector FO~M NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E×omined .............. ~...~...~......./..:./., 19 ........ Application No .... .L..%~ ............. Oproved ...................... , 19 ........ Pe~t No ..... ~ Disapproved a/c .~ ........... :""'~'7 ..........................Z~tT:5:: ................. ................ ...... ............. (Building Ins~ttor) APPLICATION FOR BUILDING PERMIT Date .....,J.~.~L...~ ................... , INSTRUCTIONS a. This application must be completely filled in by typewriter o~. 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 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 o 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 af Sauthold, 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 all applicable laws, ordinances, building code, housing code, and regulations, and to. admit authorized inspectors on premises and in buildings for necessa~/~ections. .....-~"/~~'~'~'ii~'~ ........ .... /(Addrsso appic t) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......... ~Zt~...~.....~0~ .Z'~..o.z~ ............................................................................................................... Name of owner of premises ..~~...~......~,..-.~~ ................................................. If applica~ a corporate, s~nature of ~auth~ri~d artier. ....... (Nomo ond ti~ co.orate officor) Builder's Lic~so No..ZZ..:~I.~.~--O~ ...... Plumber's License No ................................. ,~ .............. Electrician's License No ........................... : ................. Other Trade's License No ............................................... 1. Location of land on which proposed work will be done.~ap No.: ......................................~t Ng..~]...,~ ......... s,~, ~.d ~b~.~- ~~ ~. ~ ~ ~ ~ ~~..c~z~.~.¢.~m~7..~.m.tm~¢~z~z.~ze.~.~.~m~ .......... ~ Municipali~ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use ~nd occupancy ................................................................................................................................ b. ..... ........ ........... ........................................................ 3. Nature of work (check which applicable): New Build~ng.......~..... ...... Addition .................. Alteration ................ Repair .................. Removal .................. Demolitior, .................... Other Work ................................................. .... (Description) (to be paid on filing this application) 5. If dwelling, number of dwelling units ............. ~ ........... Number of dwellin~ units on each floor ..... , ...................... If garage, number of cars ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify qa~ure and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ...... ~ .............. Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of some structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ...~..~.Z..~..~. ........ Rear ..~.~2.~.~.... Depth ?.~..(~ ....... ~ 1. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning Iow, ordinance or regulation: ...... ~ ......................................... 13. Will lot be regraded'. .......~ ......... Will excess fill be removed [r~r~mis~:,(,) ~ ~ No Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate ~hether interior or corner lot. STATE OF NEW(~/YOR~KI ~ ~ [cs COUNTRY, OF ..~~..~.:...~ '~'~'~- , ........ ~~ ......................... being du¥ sworn, deposes and soys that he is the oppliconl (Name of individual signing contract) above named. He ~ the ........... ~.~~ .............................................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this applicatio~ are true to the best of his knowledge and belief; and tho~ the work will be performed in the manner set fo~h in the ~piication filed therewith. ......... ~. d~ of,.~,~ ............... , ~9:z.d~~--,~' , ~ ~ ~Z . ~ ,o~ ,.~i~ ...... ~ ...... co,,~ .~~..~.....~ ......................... ~ ' ' ' ~ I ( ) - ~, ~ (Signatur~f applicant) iI THE LOCATION OF WELLS AND .CESSPOOLS SHOWN HEREON ARE FROM FIELD OBSERVATIONS AND OR FROM DATA OBTAINED FROM OTHERS THE WATER SUPPLY AND SEWAGE DISPOISAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THESUFFOLH COUNTY DEPARTMENT OF HEALTH SERVICES FOR APPROVAL OF CONSTRUCTION ONLY DATE APPROVED rTH NOTE: · =I~fONMMENT 10T NUMBgRS REFER TO "MINOR SUBDIVISION OF STANLEY SLEDJ£$KI' UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW REVISION~ RoAO YOUNG & YOUNG 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK ,ALDEN W. YOUNG HOWARD W. YOUNG :SURVEY FOR: THOiI~,..q ~H. Zl/V/VOA/ 8 JAA/E SEA/V/lION .OT tVO. 2, "/F/NOR SUBDIVISION OF ST4flL£Y SLEDJE'SKI " AT MATTITUCK ToWN OF SOUTHOLD SUFFOLK CO., N.Y. GUARANTEED TO: CHICAGO TITLE INSURANCE CO THOMAS ~ dANE SHANNON