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HomeMy WebLinkAbout9017-zTOWN OF $OUTHOLD BUILDING DEPART/v~ENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERM. IT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9017 Z Permission is hereby granted to: · .~. :.~..o.~...~,~,z. ~...~...c...q..~...~... c..z.~ ............... ............ ~.a...t..z:...~.a....~..~..q.o.~..e.~...~..a.......c..a..~.o. gue at premises located at ... Yla::J~ Road &. 14oo.~..e.[t....~.a.~!.e. .......................................... ....................... c..u..~c ~..o.g.u...e. ............ pursuant to application dated ........................ .D..e.,~ .......... ,2.,Q .......... , 19...~...6.., and approved by the Building Inspector. Fee $.2..~:t ..0..0. ............ ~?().~ Town of Southold Building Department Main Road Southold, NY 11971 PROJECT ~ J'O}% NUMBER~ NOrth Fork CountrF Club 9ATF,: P.©. Bo;i 565~ Main }load ~,ql~ebog'ue~ NY 11931 516 722-3511 are enclosing herew.~A~h: For ~{our :Review & Co~:~nen'ks , hop FO~M NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined Dee 24 19...~.~.. Approved " " 19...~.~. Permit No. Z)~).l.~g ........................ Disapproved a/c ....... 1~1~ ........................................................................... Application No....~,Q.I.~.Z ................. (Building I~spector) APPLICATION FOR I~UILDING PERMIT INSTRUCTIONS a. 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, 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 a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, 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 necessary inspections. DonaId Dennis A,I,A, (Signature of applicant, or name, if a corporation) Aquebogue N, Y · (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Architect & Agent of owner nf nrem ses ~orth ~ ork Golf o Couutry Club Inc Name of owner ~_ ~. ....................................................................................................................................................... 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 ............................................... XXX XXXXX Location of lond on which proposed work will be done. Map No.: ........................................ kot No ......................... Street and Number ~..~.~j~p.~`.d.~.~.}.~9~.~.~..~.L~.~..~.~..~g?~g~.~.~ ........................................ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy ¢lubhouBe b. Intended use and occupancy " with a'~:~dit~o~ 3. Nature of work (check which applicable): New Building~. ................. Addition .....ll~ ........ Alteration '"'X,~ ...... Repair .................. Removal .................. Demolitior. .................... Other Work ................................................... (Description) 4. Estimated Cost ............................................................ Fee ..... 2.~,JOO ......................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ......O ................... Number of dwelling units on each floor ............................ if garage, number of cars ............................................................................................................................................. 6. If business, commercial ar mixed occupancy, specify nature and extent of each type of use .~'J.t~hO17,~i ..... 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 ....... ~(~,~.~1 ................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..I.~,~lJ...~'l~.t, ................................................................................ 12. Does proposed construction violate any zoning Iow, ordinance or regulation: "~O ................................................ 13. Will lot be regraded ....~1,O .................. Will excess fill be removed from premises: ( ) Yes ( ) No 14. Nome of Owner of premises ..~ot, t]t...ffoz, k...C~]..~..~...got~ssO:~t~l~.....fl~o~hone 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 oil set-back dimensions from prop~,*rty lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner IoL See F~led Plans £1-ATE OF NEW YORK, 1S.S COUNTY OF ..... ~.tl~:O].,k .......... .................... ~J..~l~ ............................................ being duly sworn, deposes and soys that he is the applicam (Name of individual signing contract) above named. He is the ........................ A~.~l'~'l.~;~.t,..&,..&~el~¢...o~...o~e~' .......................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or haye performed the said work and to make and file this application; that all statements contained in this application /are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the appli~bation filed therewith. \ Sworn to before me this day of De,,.~...~.e:~ , 19...~.~ ~ / (i , "'. ,/ ....................................................................... ' Notary Public, S1~;('£0]~i; County ,, r, , .... .:* _/, (Signature of applicant) NOTAt~Y pU[ILIC. Sfsf~ o{ New