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Home My WebLink About9476-z meat xo. t TOWN OF SOUTHOLD 6UILDING DlPARTMENT TOWN CLERIC`S OFFICE SOUTNOLD, N Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON,THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N° 9476 Z Date u~p:~.......~4......., 19...z~. Permission is hereby grouted to: raoactl.galloW..Pso~ertirzs...Znc.....hy...I'~.R~JBr Hill Building Corp ,,,843,,,,.,.Jericho„Tpk,,,,,,,,,,,,Woodbury. N.Y. to .~1:.~~...AFJS:IY...S~....Z;~.7.~...~e3tG.7.>i.~...~....S.lll?d~.dl.l~..AZ?...~.r.~ ~.S~.~k of premises loeoted at .«;.i~.:.t.~:-.d...c:...t;ydNS..:.Farm..aoad.: ...............................................~~'.1.isX:~.l...,.r.~ .r............................................. pursuant to applicotion dated ..........................~e~a,...3!~............., 19..7.., and appnwed by the Building Inspector. Fee 1r.f.~~............ Building Inspector 'F ..a...,. - mk''icYUeC _ - 'h.. 6x r.~'~Y+_ai We~S>Jy v_<~. 63 FOBM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. l 7 Examined ...........:..:`.~~/...`1~:.(...., 19..~!.'. APPlication No....7~f r i r~ ~~l ~ r~ Approved ............................C ...L..., 19.~..~. Permit Na..................................... Disa roved a/c _ ...............................~L:~!.........~..,.~..~.~...:?~::~:......................... 'fBuilding Inspector) APPLICATION FOR BUILDING ERMIT Date .............Septemb~r..~.r~............, 19.7....... 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 state. 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 drown on the diagram which is port 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 o Certificate of Occupancy shall have 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 Ordinnnce of the Town of Southold, Suffolk County, New York, and other applicable Lows, 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 fo admit authorized inspectors on premises and in buildings for necessary inspections. fires. (Signature of applicant, or name, if a corporation) F.t,4WfiR..Hd.I.L..E3l71LIliP1G..CORP(IEc~T1.44d...~~ly..Jer••achc~••~Fp.ke (Address of applicant~4loodbury, i!Y State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Generel Gontraceor Name of owner of premises .....t"~S!~dhR1.7.aw..C?raparta•e~...Ince If applicant is a corporate, Signature of duly authorized officer. Pc.~.~.i.det;t (Name and title of corporate officer) Builder's License No. .E:~.7~;~:~?d!~Q.9~J Plumber's License No. . ~dO..'~P.. k2e,.~u.i red,,,,,,,,,,,,,,,,,,,,, i Electrician's License No.I')P.O.@.. ~~qU,j.Ct;~t Other Trade's License No . (SG-t,~~ ~'f~ vc,,~__ v~~~~ 1. Location of land on which proposed work will be done. Map No Lot No...:..:..:.~.......... q i • Street and Number ....../.V!~~?:::--,..~`~C~:..t., c.{KU--... ~ c'„~n,. -~C .........t ..c.~,.,°y-~s,,-.-.. . l J.. ~ ..............1::..~.. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: r I ~~c t o. Exisiting use and occupancy ......~.......::::4.....::amt....~_ b. Intended use and occu ant ~.l 3. Nature of work (check which applicable): New Building Addition Alteration . Repair Removal Demolition.................... Other Work (Description) f ~-U 4. Estimated Cost .............................~............................Fee ...I..~................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................Nt:rnber 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':~:~:~i::'•• 7. Dimensions of existing structures, if any: Front Rear Depth . . I-leight Number of Stories Dimensions of same structure with alterations or adu'iiions: f-rant Rear Depth Height ............................Number of Stories II. Dimensions of entire new construction: Front Rear Depth Height Number of Stories 9. Size of lot: Front ILecrr Depth _ 10. Date of Purchase .........................................................Nome of Former Owner 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation : 13. Will lot be regrarJed Will excess fill be removed from premises: ( )Yes ( ) No 14. Name of Owner of premises Address Phone No....................... Name of Architect Address Phone No....................... N„me of Contractor Address Rhone No....................... PLOT DIAGRAM I_ocote clearly and distinctly all buildings, whether existing r proposed, and indicate all set-back dimensions from property lines. Give street and block number or description c®c~jng to deed, and show street names and indicate .vhether interior or corner lot. ~ ~ ~ S G rt/ s Q SPATE OF NEW YORK, t S.5 COUNTY OF ................................f '~jhomaP~ Uhl ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,being duly s~roorn, deposes and says that he is the applicant (Name of individual signing contracf) above named. I-le is the ......~~.9gY1~.................................................................................................................. (Contractor, agent, corporate officer, etcJ 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 the best o is Knowledge and belief; and thar the work will be performed in the manner set forth in the application filed t rewi Sworn to bef e me this day of .........~T 19.h,/' Notary Public . County (Signature of appli ant) '~,,C NARY ~pUt;r~^!~~\^il-iAi .rj~ ~ i ~ a4 Now York Qu ili Ffca~ is PJae~.w Cnupiy Commicslai~ Eup',.y~ P,1 ,r^;, 30; I'~~