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Home My WebLink About10355-z FOI~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTI'~OLD, Nm. y. BUILDING. PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) N? 10355 Z Permission is hereby granted to: ...... .~.~,.,~,,..~.....~.~ ............... ~..~...~,...~.....~~. ~. ..... ;.~,~,~.....~.....~;~ ...... ~ ...... ~, ........................ at premises located at ~.(~.....:~~-.~?...,~~/ Building Inspector. Building' Inspector FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 /~, TEL.: 765.180:3 Examined ff~..~../.'~. ..... , 19~. ~'. ~ _ Application No../.(~.~.~. ......... ...... / Disappr°ved a~c ' ' ' ~' ' '-}'-! ' ' "L'"' '-~=-'--~' ' ' '~~.~.,~ · ' (Building InsPector) APPLICATION FOR BUILDING PERMIT ,,/ Date ............. ~././..~. 19.~/ 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 lodatibn of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. 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 described. The applicant agrees to comply with alt applicable laws, ordinances, building code, housing cod/fi, and regulations, and to admit authorized inspectors on premises and in buildings for neces~a~ inspections. / ~dre of applicant, or name, if a corporation) .A. 9.u.g.~..25.A ~..159.c.k. 7..~p. 1..ri.g,..I~w. Xq,.k.1 .'[7. 7.6. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .... Ag. ent Name df owner of premises ......... ~o..s .ep.h. ?...J.o.~.n...B.a.s. 1..1.e ........... ;,'/~' ~" .~.~.~,.~.~..~ ........... (as on the~a~ ~ll-~ate~ a-ced) If applicant is a corporation signature o f duly authorized officer. Builder's License No .... .~1 .................. Plumber's License No .... Electrmmn s License No ...................... 0 Other Trade s L~cense No ...................... 1. ~ocation of land on which proposed work will be done .......... .~.~.~. .4 ............................. 695 Westwood Lane Greenport House Number Street Hamlet co~tv ra~ ~ ~o. ~000 sootio....~Z~ ......... mo~k ...~ ~ .......... rot .... ~. f~ .... Subdivision .~P. P,~ .$~.~r¢..db9rP.s.r ~9~9~..~iled Map No...4~ ....... Lot .... .?,q ........ (Name) 2. ~tate existin~ use and ~cc~pancy ~f premises and intended use and ~ccu~ancy ~f pr~p~sed c~nstructi~n. a. Existing usa and occupancy one fsmil~ ~esiaenee ~. ~ntenaed use and occupancy ...1.~. ~..~. ~n~rg~n4. ~.i.~¢~ .~gPX .~¢~h .4 ~. ~.~9~ ............. 3. Nature ofwork (check which applicable): New Building .......... Addition .... .X. .... Alteration .......... Repair .............. RemOval .............. Demolition .............. Other Work ............... (Description) 4. Estimated Cost ..... ~.2.9.~., ~0.0. ....................... Fee ...................................... ! (to be paid on filing this application) 5. ] f dwelling, number of dwellinglunits ............... Number 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 ..................... 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 .... .~J.~.! .' ............ Rear ....... .~3.~.~ .......... Depth ..... 1.~..0.' ............. 10. Date of Purchase .......... i .................. Name of Former Owner ............................. 11. Zone or use district in which premises are situated ........................... Iq'o' ....................... 12. Does proposed constrnction~lsate any zoning law, ordinance or regulation: ................................ 13. Will lqt be regraded ...... .~: .................... Will excess fill be remoyed fr. om premises: . Yes 14. Name.of Owner of premises~---R/?.. ~../.<~;.... Address ~_.~... _~, ~'~. ,~, .'~,.'. Phone No..~. ~..~[.'./. ·..~. ·. N/A , ~~ ~ '~' Name .of Architect .................. ., .......... Address ................... Phone No ...... ~, ......... W.m~-~ ......... Swim-KINg Poo±s a ...... aou~e 25A ...... /44-oluu Rocky Point, N.Y. 11 778 i PLOT DIAGRAM Locate clearly and distinctly al! 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. STATE OF NEW YORK, S.S COUNTY OF .................. ............ M.. g.'fga.~, e..g..F.~. 9 .s.g ..................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ..................... I .~gel~.t. ............................................................. ~ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is d61y 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 of his knowledge and belief; and that the work will be performed in the mann. er set forth in the application filed therewith. Sworn to before me this /.~... day of... 19 Notary Public, . ......... ~c/ ...... County (~1/~ .... ,~ .~ / ........... 'v y.~[~.~e'~rw ~2.,. (Signature of applicant) ~ allr~ed ~n Suffolk Countv bomm sS~on Exprres March 30: 0 m~ F' SWIM-KING POOLS, INC. ROUTE 25A ROCKY POINT, NEW YORK 1I F m 0 A