HomeMy WebLinkAbout9151-z FORM NO. ~
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
ToWN CLERK'S OFFICE
$OUTHOLD, N. Y.
N?
BUILDING PERMIT
(THIS PERMIT MU KEPTiON THE PREMISES UNTIL FULL
COMPLETION OF THE WORKtUTHORIZED)
/
Permission is hereby granted to:
Lon~...g.~'~.~..~,e~.a.....,G¢'..~... ~.¢4~,...A~.h.~,t;. ~ .....
............ t~.o.u,t~J,d .................................................
at premises located at .....~.~..~..g..~....?.~.~...~...~ .................................................................................
................................................ .o.r.~.n.~ ..................................................................................................
pursuant to application dated ..........................~..~...~......~.] ............... , 19.~..?..., and approved by the
Building Inspector.
Fee $,~ ...........
YORK BOARD OF FIRE UNDERWRITERS
THE NEW'
ak 85 JOHN STREET, NEW YORK, NEW yORK 10038
he el~trical ell ,ipment ~ described bel~ and ,ntrod~ced by the appl,e,n¢ ha,ned on the abce
!liam Ashworth, 670 Oyster Pond Lane, Orient, L.~. '
i,, thofollow~ngl~atlon; Bmsen,ent ~ Ist Ft. '~ 2nd Fl. . OUtSide Section Block
,~,,,~.~.,~¢,,¢~o,~ August 25, ~977 andfo[tndtobeincompliancewiththereq,,iremet~tsoftbisB°ard'
2O ;[7
Ru%and E.%ec.Co. ,; , '
P.OoBOX 3.43
Mattltuck, L.I. 1.%952
· Lic~2~2E .
D
This certificate must not be altered in any' manner; relurn to the office of the Board if incorrect· Inspeclors may be identified by their c
TOWN OF SOUTHOLD
TOWN CLERK'S OFFICE
j ~UTHOLD, N. Y.~
Examined ............ Z ................. ,
........................................ , .................................
Disapproved a/c ..... ~,~':~ .................. ~ ..................
Date
INSTRUCTIONS
a. This application must be completely filled in by tyjS'_ewriter o~ in ink and submitted in triplicate to the Building
Inspector, with 3 set~ of plans, accurate plot plan to scale. Fee according to schedule.
b. Plat plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets
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 o 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 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.
Long Creek Homes Inc
(Signature of applicant, or name, if a corporation)
So~.thold
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
................................................................ ..................................................................................................................
Name of owner of premises ...~.~..:[Ls..~'Kq~.~q~.z .................................................................................................................
If applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No .....................................................
Plumber's License No .......... ..b..e..Z..-]~.r. ..........................
Electrician's License No ......... .Z2...q.]..~,~. .....................
Other Trade's License No ...............................................
1. Location of land on which proposed work will be done. Map No.: .............. ~ ..................... Lot No.....~...~. ................
Street and Number ......... Oy.,~J~,z:,,,~o~d~.....I,~ ......... O.~.$~.~t.'~ ...........................................................................
Municipality
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
vaca~it
a. Exisiting use and occupancy ................................................................................................................................
b. intended use and occupancy ........... .......................................................................
3, Nature of work (check which applicable): New Building~ XXX Addition Alteration
Repair .................. Removal .................. Demolitior, .................... Other Work ...................................................
(DescrlptJon)
4. Estimated Cost ................. ~.L.F..0..0..,0...--+ .......................... Fee 6.9.'~0. ........................................................................
(to be paid on filing this application)
o~e
5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................
If garage, number of cars ...~ ........................................................................................................................................
6. Jf 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 ........ ~.7~6 ...................Rear ...... .br.~..':..6. ............ Depth ...,~..6. ................
Height .................... Number of Stories ...... o,g_e .........................................................................................................
9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................
10. Date of Purchase ........................................................Name of Former Owner ........................................................
1 1. Zone or use district in which premises are situated ....... ,~,.....C],,]-.~.~ .............................................................................
12. Does proposed construction violate any zoning Jaw, ordinance or regulation: ...... .~...O. .............................................
13. Will lot be regraded ..... .:fe.Z ............... Will excess fill be removed from premises: ( ) Yes ( ) No
14. Name of Owner of premises ..... ~b]~L~..._-~sh~.oz'.'J~b ............... Address ....... .0.r..i,e.,g..t. ........... Phone No .......................
Nome of Architect .............................................................. Address ................................,Phone No .......................
Nome of Contractor ..~.o...1].~....g.~'.~.~,..~..O.~..~ .................... Address .....~.g.~.t.J).9.[~. ........ Phone No .......................
PLOT DIAGRAM
Locate clearly and distinctly all 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.
see fi~ed plans
STATE OF NEW YORK. [c c
COUN FY OF ...... ~1~,¢'...].]4. ........ [ '
......................... ]~,,...}3~).~e~ .................................................... being duly sworn, deposes and says that he is the applicam
(Name of individual signing contract)
above named.
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work end to make and file
th s app cot on; that all statements contained in this application are ,t~ue to the best of his knowledge and belief; and
thor the work will be performed in the manner set forth in the applica~oj~ filed therewith.
Sworn to before me this
1 Mar 19 ~.~
...... . ...........................
JUDITH T. TERRY
Notary public, S~nte of N~W Yor,~
52.034.4-0,53 ~Lffio!k cour?y~.,/,,
NO.
Comrnlsslon Expir¢s March 30, 3.~J