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Home My WebLink About7302-z FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMEblT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISI~S UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne 7302 Z Date ........................... ~T ~tq e ........ 6 .......... , 19...~.~. Permission is hereby granted to: ...... };.. ~,a~:u<...C. ic.,h ~,I~ ~.~z;i.~.;~..... I' .......................... .................... .~t~chcig~.te .................... ~, .................. ~o ..~-~,l~...n._~¢...ac.c~.a,~P.~:~...s.~ol'.f~,~.~....~..tL ;l-.~,L..g .......... : .......................................................... at premises located at ....~.g~....~......l.{..~.g..~..o..~....A..~...~..e...~. ....................................................................... ........................................ L~,pi~.. L~r.£~.e .............. C.~l;~,hagt~i .......................................................... pursuant to application dated ............................... ~T~F~.e ........ ~ Building Inspector. Fee $.,..~ .O.,,[).O ......... ..... , 19~..1~..?., and approved by the FORM NO. 1 TOWN OF SOUTHOLI~ ~UILDING DEPARTMEI~iT ,TOWN CLERK'S OFFI~ ~UTHOLD, N. Y. ............................. ................ INSTRUCTIONS Date J~e 6 19..?LF Ltl a. This application must be completely filled in by typewriter at in]ink and submitted in triplicate to the Building Inspector, with 3 sere of plans, accurate plot plan to scale. Fee accord nglto schedule D. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or 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 heroine issuance of Building Permit. ~d,., ~U,pon_appr. o, val of this appli,ca, t on; the Building Inspector will issueia Building Permit to the app cant. Such permit shah De Kept on the premises ovoiloDle tar inspection throughout the wor~k , e,., No building shall be occupied or used n whole or in port for any nurnose whatever --~:l _ snail have been granted by the Building Inspector. , APPLICATION IS HEREBY MADE to the Building Department for thei issuance of a 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 ilar removal or demolition, as herein described. The applicant agrees to comply with all applicab eaws, ordinances, buil~in]j code, h0g,J~ng code, and regulations, and to admit authori zed inspectors on p rem ises and in buildings for necessa~6,/~i~/// (Signature of apbiic~g~Z~or n~'n~e, if a corporation) Cutchogue , ............................. .............................. State whether applicant is owner, lessee, agent, architect, engineer, generpl contractor, electrician, plumber or builder. ................................................................ Name of owner of premises ....~.~.~,l¢...~.~,g~f~,g,.O..~.~..o. ~ 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 ............................................. 1. Other Trode's License No ............................................... ~.~ Location of land on which proposed work will be done. Mop No.: ...J ...... -t~.¢.]~.9.~.~r...~..Q.... Lot No..~ .................... Street and Number 117, ' · .. ~Dzn D~i.v.e C~tcha .ue .. Municipality State existing use and occupancy of premises and intended use andloccupancy of proposed construction: a. Exisiting use and occupancy ~.~.].ing ~ b. Intended use and occupancy same with accessory, st.qrag~e building. ...... 3. Nature of work (check which applicable): New Building...;~: ........... Addition .................. Alteration ............... Repair .................. Removal .................. Demolition .................... Other Work ..................................................... (Description) 4. Estimated Cost ............................................................ Fee ...... .1..0.4..0..0. ........................................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units .......... .0. ................ 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 type 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 ........................ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ...... t.t.A..~!...~..~..S...~. ............................................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ...... ~O ............................................. 13. Will lot be regraded ..-..tt.~ ................. Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises ...~......~,~f~0.W.:~;~ .............. Address ................................ Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor .......... ~.f~,6t ......................................... Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly al/ 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. L_ STATE OF NEW,,KQP~I(,,- ~ c c COUNTY OF ............ Frank Cichanowic z ................................................................................................ being duly sworn, deposes and says th he is the applicon~ (Name of individual signing contract) above named. He is the .......................... .°,.~fg, c,~,...b.,,u:.~.~.~..e...r. ....................................................................................................................... (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 application ore true to the best of his knowledge and belief; and tha~ the work wilt be performed in the manner set forth in the application fi/~,~ therewith. Sworn to before me this ('///'7 ,/~ // ..................... of ................. ................. , ' Notary Pubhc, . ................................................... County .......... ...~,-~r..~....;i....:~..~...-~x.~ ............................................. I ~ (Signotur~,/'~ applicant)