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Home My WebLink About8754-Z FOK~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P'~EMISES UNTIL. FULL COMPLETION OF THE WORK ^UTHORIZED) N? 8754 Z Permission is hereby granted to: .... ~z~r..~aoz..~C..g~zl&~qe~..l~z~ .......................... l~l.:t.l, uck ................................ ,o ~..~..~..t.?.~...o.~.......z...t..,.~.~..~.~.e.~.~ ~ ................................................................. at premises located at ....]e.~.t,..~. ........... J~A~;.t,~..~.l~k..Y, lt~t, ll ....................................................... ................................................... .~arAlaal .~rJ.v.e .......... ..Ma~t £tuak. ........................................ pursuant to application dated ..................... eT~l~y ......... '~'7' .......... , 19r~ .... and approved by the Building Inspector. Fee $~lBaJ~[O ............ (Building Inspector) APPLICATION FOR BUILDING PERMIT'~(~ ~, · ...... o. ~is a~lic~i~ m~ b ~plely fill~ in by ~writer ¢ in i~ ~ ~miff~ in triplicae to ~ BuiB~ In~r, w~ 3 ~ ~ ~, ~ ~ plm ~ ~M. P~ ~i~ ~o ~n~um. b. Plot plon ~i~ I~i~ of I~ ond of ~ildi~ ~ premis,, relotionship to ~jo~m~. premiss or~s, ond givi~ = ~tl~ ~rlpti~ of I~ ofp~ must ~ drown ~ the diogmm which is c. ~e ~ c~ ~ ~b =~licoti~ ~ n~ ~ c~me~ before i~uonce of Buildi~ Pe~;t. d. U~ o~ol of ~is ~li~i~, ~e Buildi~ Ins~tor will i~ue o Building Permit to the ~licont. Such ~it shol~ ~ ~ m ~ p~mi~ ~ll~le ~r In~l~ ~t ~ ~rk. e. No ~ildi~ ~11 ~ ~c~ or u~ in ~ole or in ~ for ony ~me whoever until o Ce~ific~ sholl have ~n gmn~ ~ ~e Buildi~ I~r. APPLI~TI~ IS HEREBY ~DE to the Buildi~ ~ment ~r ~e i,uo~e of ~ Bui~i~ Permit p~nt Bui di~ Z~e ~ ~e ~ ~ T~ o~ ~old, ~ffolk C~n~, New Yo~, ond ~er ~llc~le ~, um;~es or Regularly, for ~ c~i~ ~ build~s, ~lti~ or olterati~s, or for ~0 or ~ iti~, os heroin ~ri~. ~e opplicont ~ ~ c~ly with oil =~licoble I~, ordi~., ~ildi~ c~, h~i~ ~, odmit out~Hz~ i~o~ ~ pmmi~ ~ in ~1~1~ ~ n~ i~ti~s. ............ ............................. ..... (A~mss of ~licont) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or buil.der. Name of owner of premises ..... ..~7.....~..~._..~n~~,~ .......................................................... 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 ............................................... Location of Iond on which proposed work will be done. Map No.: ..../~..~....=~~t No ..... ...~?.. .............. Municipality State existing use and occupancy of premises end intended use and occupancy of proposed construction: 3. Nature of work (check which applicable): New Building.. ................. Addition ~ Alteration Repair .................. Removal .................. Demolition .................... Other Work ................................................ . .... ~-, (Description) 4. Estimated Cost .................~..~.i.~ ............................ Fee...../~J~-'~................................................ ..................................... (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 t~pe of use ............................ 7. 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 ....... ].. ....................... 8. Dimensions of entire new construction: Front .............. ..~. ................... Rear ....... .~'.. .................. Depth ....... .(e. .............. Height ................... Number of Stories ............... ]. ..................................................................................................... 9. Size of lot: Front .. / ~ .~.' Rear ................ .~..~...~ ................. ..................................................... Depth ....... .~'...~..~. ................ 10: Date of Purchase ............... (.R.I..~...~._ ........................... N~m~e ~of~ Former OwnerJ~.'~..q..~..S.~......~...~ 11. Zone or use district in which premises are situated ..................................................................................................... H- 12. Does proposed construction violate any zoning Iow, ordinance or regulation: ........................................................ 13. Will lot be regraded ........ ~/.¥....O. ............ Will excess fill be removed from premises: ( ) Yes ~ ) No 14. Name of Owner of premises ...~..:....¢/~..)t..~...o....~..~ ................. Address/~..~..?.~..~..e..~.~b.{..'*..~ Phone No. 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 all 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. STATE OF N~ YORK, ~ c c .......... ~..~.....~.~..~.~ .......................... boin~ duly ~worn, deposes ~nd sey~ thor h~ i~ th~ opplican~ {~om~o~ i~ividu~l ~i~in~ controcO *bow n~m~. He is the ................................................................................................................................................................................. {Controctor, o~nt, cor~rot~ officor, ~tc.) of sold owner or ownors, ~nd is duly ~uthori~ed to perform or hov~ par~ormed the ~oid work and to mk~ ~nd file thi~ oppllcotion; t~t o1~ ~tot~m~nt* contained in this ~pplicotion ~r~ tru~ to th~ best o{ hi* know~ed~ ond belie{~ ond th~ th~ work will ~ p*rformed in th~ monn~r set {o~h in the ~pplicotion fil~ th*r~with. Sworn to b~{om m~ thi~