The URL can be used to link to this page

Home My WebLink About7116-z FO~! ~0. ~ TOWN OF SOUTHOLD BUILDING DEPARTMEN1 TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne 7116 Z Permission is hereby granted to: pursuont to opplicotion doted ............................. ~!0.~ ........ 't.0..~**.**, 19~.~..., ond opproYed by the Building Inspector. Fee $ ~.~ .,0~ ............ Bulling Inspelor FOI~M NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGEi $OUTHOLD, N. Y. Examined ~--'/~'/-~ 19Z.3.. Application No. -?// Approved .... ~..~..~....../.i~.. ............. ,9..~./. Permit No. ~.~/Z.~..~.~....; ............ ................. ........................... APPLICATION I:OR BUILDING ~'ERMIT 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. ~ee according ~to schedule. b. Plot plan showing Iocatio6 of lot and of buildings on premises, relatibnship to adjoining premises or public streets o~ areas, and giving a detailed description of layout ofproperty must be drawn ~n the diagram which is part of this application. c. The work covered by this application may not be commenced beforle issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue ia 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 pa rt for any purpose whatever until o Certificate of Occupancy shall hove been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of o Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances ok_ Regulations, for the construction of buildings, additions or alterations, or ~or~moval or/,dem, c~ion, as herein describe~ The applicant agrees to comply with oil applicable laws, ordinances, b~pif, d?ng c~.de, h0~ing~ode, and regulations, and admit authorized inspectors on premises and in buildings for nece~sdW ids¢¢ons. "' "'"~:~gnoture of applicant, oTme, if a corporation) ........ ................ (Addross of opplic~nt) State whether applicant is.owner, .lessee, agent, architect, engineer, generbl contractor, electrician, plumber or builder. ................... Owo.e.~. .......................................................................................... ............................................................................ of ramies ~$ra~"s Cove Ha~ine, Inc. Name of owner p s ......................................................................... If applicant is a corporate, signature of duly aufhorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No. ~.t...~P..h...n....B..a..d...a.~....3.?..:....../t.6..2.-P Electrician's License No. Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Mop No.: ...t...2...2.~...(.~.9.~ ............ Lot No ........ ~ ............. Street and Number ..P.a~£aau3,a..R~zi.,..F.~bez'~...lis].apd.~...~te~..~o2~ .......................................................... Municipality 2. State existing use and occupancy of premises and imended use an, occupancy of proposed construction: a. Exisiting use and occupancy ...................................................... . .......................................................................... b, Intended use and occupancy ......... .~.~.a.?.,.~ ............................................................... 3. Nature of work (check which applJcaNe): New Building ..... ~ .......... Addition .....X. .......... Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work .................................................... (Description) 4. Estimated Cost ........ ~.5..!~..qg.....g.a. ................................. Fee $50.00 (to be paid on filing this application) 5. If dwelling, number of dwelling units ..... ~ ...................... Number of dwelling units on each floor .w. (:.~.~..:.7;~z.~ .... If garage, number of cars ..................... z;:.;.;=.:~=;;;:-.:; ......... .,,..,.,.,,.,.....~,~.;............:,~;.;~....r.....~;:.. ........ - ...................... 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 ..~..o..: ........... Height .....;,-~. .............. Number of Stories ........ .~..... .................................................... ~, ............. Dimensions of same structure with alterations or additions: Front ....... ,~..~. ...................... Rear ..... ./..~.. ................. Depth ....... ~J~.../.....~....~.... Height ....~./..~ ................ Number of Stories ..... ~. ....................... 8. Dimensions of entire new construction: Front ........... ~...~.. ................... Rear ....J..~ ................... Depth .>.~..O.. ............... Height ...../.~.~....~. ....... Number of 9ories ..................... ........... ; .................................................................... 9. Size of lot: Front ................~....~... ............................... Rear ..... ..c~...../~.. ............................ Depth ...!~.~...~..~r~. . 10. Date of Purchase ....... ~D.g.,...~,~.G..~. .............................. Name of Former Owner .~.[~p....H.@~/p. fl.~'.~. ........................ 1 I. Zone or use district in which premises are situated ................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regutotlon: ...... ~ ............................................ 13. Will lot be regraded ..........~.~) ............. Will excess fill be removed from premises: ( ) Yes (X) No 14. Name of Owner of premises .~.~.~.l.~.,g?..u.~...H.~.~.n.~.!...~.n~ldress ..F..~.?,h.~?....~]... ....... Phone No.5~..'.~.8..8..~..5.~~ Name of Architect .............................................................. Address ................................ Phone, No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions frorn 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 E~/~ .YO..RK,. ~. I. S S COUNTY OF ~ ........... ~ '~ ............................... · ~.;.....(J..-.~...'.~....:~ ................... being duly sworn, deposes and says that he is the applic~nl (Name of individual signing con~ract) above named. is the .............. 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 are true to~e best of h½s knq,~Lgdge and belief; and that the work will be performed in the manner set forth in the applicatio~mffJled therewith. // / Sworn to before me this /' ,,/ // / Jklotary Public, ......~.~..~..:~~.... County .................. ./_:~...~.../.~.....~.~ .......... T~ ....... . ( k/ (Signature of applicc)~t) LUCY J. AHMAN [~ota~ Public, State of New yot~ No. 52-0028880 Oue, lified in Suffolh Count~ ~.- Te~m expi]~e~ M~eh 30, 19 ~,