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Home My WebLink About7759-z FOR3~ NO. ~ TOWN OF $ouTHoI~D BUILDING DEPARTMENT TOWN GLERK'S OFFIGE SOUTHOLD, N~ Y. BUILDING P, ERMIT (THIS PERMIT MUST BE KEPT ON 'rHEPP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 7759 Z Permission is hereby granted to: T~f~..Fel'~..Fen, e..~e..,.A~¢,.~a.tm~n~...H~rbor Inc ........... 1~att -Lt~3~ ............................................... Fo ..e~.ec.t..~L..im~:Lut~:Ln...~.t..~£gh...p~. JR..£ea~;iiag. ......................................................... at premises located at .~e~t;..,RoaA..&..~eaH:..:~ek...A.V4~ .......... Fle~t,$...lqe~1~, ....................... ............................................... g~.¢.~..o, g~te. ....... ~.., ~., ........................................................................... pursuant to application dated .................... ....~.&..~.~.~.].~,.,...~ ........ , 19~.~...., and approved by the Building Inspector. Fee $.~.~,1~0 ............ uilding nspector ~ Examined !...~... ~x.r~, /~ 7-~' .................................... 19~,,.,~ Approved ........................................ , 1 FOEM NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y.~ Permit No. 77 ~'~'~' ^pplicotion .o...7.. AI~PLICATION FOR BUILDING PERMIT INSTRUCTIONS o. This application must be completely filled in by typewriter o~ in ir~k 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 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 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 Department 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 describfd. 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 necesso~/ inspections. ~ (S gnature of ep~l ~nf, or nome, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .............. ................................................................................................. Name of owner of premises ...~.~x't.~.~..g.....~/~...~..~. ................................................................................................. 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 ............................................. Location of land on which progose~d work. will be do0e. Mep h(~:t'.... ................................... ~ L.ot No ........................ Street and Number .:~./,4~d;."/~.~,,'.~.~d,e,,~..~(:..:~.~/~./~....~, .......................................... :~J~.~M~,. ........ · t~ugi~pollty ' State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy./~/t~,¢/~,,~ ........ ;~....../ ........... ; .................................................................... b. ,ntended use and occupancy ...., ...................... ~........Z~,~ ...,, / / property lines. Give street and block number or description whether interior or corner lot. 3. Nature of work (check which applicable): New Building .................. Addition ........... .,:~).. Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work ........ '/"~'~'~i~i~ ........ '"' 4. Estimated Cost ............................. ,~,f,~.~,...(~...~. ...... Fee ............ .~'..,~...'~...(.~..~ ....................................................... (to--"~ '~'be lJa~cl 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 basJness, 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 ............. ,~.,l~....~..~...~. ................ Rear .......... ~.~..~.~ ................... Depth ...... ~'.~,~..'~.., .......... 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 1 1. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded ............................ Will excess,fill be removed from prer~ises:~( ) Yes ( ) No 14. Nome of Owner of premises~.~~..~ ........ Address .~.~..~.....:. Phone No.Z.~...~...",L.~.~ Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or p~ ~and indicate all set-back dimensions from eed, and show street names and indicate ',- . .?, k '"7;:r'- '1 .......... · I. ....... $ ........ ~..1 ........................................................... boing duly sworn, deposos *nd s~ys thor he is the ~pplicom ~ (~me ~ individual .si~nin~ contract) above named. - z ] He is the ........ ,.~ ................................................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner qr owners, and is duly authorized to perform or have performed the said work and to make and file this apl~licotion; that oll statements contained in this application ore true to the best of his kno~ge and belief; and that th~ work will be performed in the manner set forth in the opp co~ Sworn t~ before ~e this ,~ ................ ........... .. ~oto~ ~ub~c, .....~~,7~~unt~ ......... :.~:.~..~ ...... ~ ........ : ....... : .................... ~ .......... ~ ' ~ ~ ~>i~norure o* ~ppdc*ntl ......... , .... H