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Home My WebLink About10248-z FOHM NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFIGE SOUTHOLD, N., Y, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION~ THE V)/O~K AUTHORIZED) Permission is hereby granted to: ....... Zi¥.~i ................. ~;...,~.,.~T..x~... ..~:,,..4./..Z...-.:.~<..z..~..~.~..c~ = ....~.....~7~ .~...~ .~. .,~..~..i......~..~...~Y~,.z/.~ ~...~...r~.Z/...{./..~ ........................... at premises located a,-~../..~.~.~......~../~....~..~ ............ : ....................................................... pursuant to application dated ......... ~./.~/~. ........../.. ................. , 197.~.., and approved by the Building Inspector. Fee ,I, ........... ~:4..... TOWN OF $OUTHOLD ' BUILDING DEPARTMEN'r TOWN CLERK'S OFFICE 'OUT.OLD. N. ' (~'uildi Inspecto APPLICATION FOR BUILDING PERMIT Date ...... J. un.e,.. ,1, ........................... , 19...7..9. .... INSTRUCTIONS a. This application must be completely filled in by typewriter o~. in ink and submitted in triplicate to the Building Inspector, with 3 sete 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, N~w 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 Paws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. INLA~ND HOMES, INC. (Signature of applicant, or name, if a corporation) Box 117, Mattituck, I~.Y. 11952 (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrlcian, plumber or builder. General Contractor Name of owner of premises A~g.~.~C.~.~,~...~:~,~.~,~.~I~.Q.'G.~. ............................................................................................ ~ ...... If applicant is a corporate, signature of duly authorized officer. Robert E. Hiltz. Pres. (Name and titJe of corporate officer) Builder's License No ..................................................... Plumber's License No. 5...1..7.?.?. ..................................... Electrician's License No. ~,~,8.,,-,,E. .............................. Other Trode's License No ............................................... "Sunset Knolls" Location of land on which proposed work will be done. Map No.: ...~..c..t...i..o...n....2. ................ Lot No....3. .................... Street and Number ...~.t;..~..1..e.Y....~.o.f%.d-..¢...~G.1;.~..~.l~.g.q~., ........................................................................................ --~/~.-~C) ~ Municipolity State existing use and occupancy of premises and intended use and occupancy Of proposed construction: a. Exisiting use and occupancy Vacant 1 - Famzly b. Intended use and occupancy ......................................................................... ~ ................................................... 3. Nature of work (check which applicable): New Building' ...x...x..x..x.. ......Addition .................. Alteration ................. Repair .................. Removal .................. Demolitior ................ /.'" Other Work ................................................ . .... ~ 0¢,':~/' (Description) ooo.o 4. Estimated Cost .....~.......) ............. .u. ................................ Fee ......... ]..%,~..../.. ................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ......... ~k ................ Number of dwelling units on each floor ............................ If garage, number of cars ............ 1 ............................................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, Jf 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 .....5..0.. ......... j ................. Rear ....... .5...0. ................ Depth .....2...2. ............... Height 18..................,. Number of Stories ...................................................................................................................... 9. Size of lot: Front .... .1...2..O. ............................................. Rear 121 Depth 193 10. Date of Purchase ....................................................... Name of Earner Owner ........................................................ · 0.{7 .z< 11. Zone or use district in which premises are situated .............. /...¥ ................................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: no 13. Will lot be regraded ....~...e..s. ................. Will excess fill be removed from premises: ( ) Yes (×) No 14. Name of Owner of premise~n.d..r..e..a...s..C...h..a...r..a..1...a..m...b..°.u.,s. ......... Address ................................ Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ,I~NDA~.D...~{Q~F,~.,...~.N.C..: ................. AddressB..°..x.....1..1...7.....M..a...t..C..i..~q~n!6ne No..2...9..8..-...9..6...9..6.... 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. /4'/.77" STATE OF NEW YORK, t ( ~ COUNTY OF ................................ Robert E. Hiltz ' , 'ul r ................................................................................................. De'ng Ouly swo n, deposes and s~ys that he Js the applJcanl (Name of individual signing contracf) above named. Contractor He Js the ................................................................................................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove 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 tho~ the work will be performed in the manner set forth in the application filed therewith. / Sworn to before me this · / ........................ day of ............................................ , 19 ........ · Suffolk Notary Pubhc, . ................................. -, ................ County ~...~....~.~..%d.-~:.w...~-~.~¢.., ......... +...~ ...............................