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HomeMy WebLinkAbout20298-Z l~O~3f NO, · TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) -' ..... 7'""'""~'""'~-J,~ ............ ..... ~.~ ................ :...' ................................................................................ ~.'.iiiiZiiiii at premises located at .......... ..~...~.....~../....~...~...~ County Tax Map No. I000 Section .......... ~...~.... Block .......~ ......... Lot No ........ ~ ........... pursuant to application dated ........ .~.~......~....,~.~ ........ , 19..~.~., and approved by the Building Inspector. Builcllng Inspector Rev. 6/30/80 xamincd ~ovember FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 isapproved a/c ..................................... Mr. Curtis Horton (lluilding Inspector) APPLICATION FOR BUILDING PEFhMIT INSTRUCTIONS 80AKD OE H~ALTII ......... 2 sETS Ok' PLANS .......... SURVSY ................... CllECK .................... SEt'TIC F 0 ?,,'l .............. NOTIFY; CALL ................... ri^IL TO: Date ...No.v.e~'D~r..2.2 .., 19 .~1 a: This application must be completely filled in by Wpewriter or in ink and submitted to the Building Inspector, with 3 ; of plans, accurate plot plan to scale. Fee according to schedule· b. Plot plan showLng location of lot and of buildings on premises, relationship to adjoining premises or public streets areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appLi- :OH. c. The work covered by this application may not be c'6mmenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit !I 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 i1 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 ding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or ulations, for the construction of buqdings, additions or alterations, or for removal or demolition, as herein described. apphcant agrees, to comply with al/ applicable laws, ordinances, building code, housing code. and regulations, and to :it authorized inspectors on premises and in building for necessary inspections. (Signature of applicaut, or nan:e, if a corporation) · ?5..57.(,. 2. ?.z.,.v.%' 0. ...... (Mailing address of applicant) whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Otd / i . .................. of owner of premises .... ]~O.LI.'.,4-L, ~ ~ .j..'"~...'O. dZ.'~'7 .~"~.. ....................................... (as on the t:[.t roll or latest deed) plicant is a corporation, signature of duly authorized officer. " (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ........... ; ............. Electrician's License No ....................... Other trade's License No· /~.~ .tS/~..~../~r~..*~..t~.~,~,{ Fishers Island, New York ~cation of land on which proposed work will be done .................................................. no ~ Fox Avenue/Crescent Avenue Fishers Island )usc Numbcr Street Hamlet unty Tax Map No. 1000 Section ...0.06 ............ Block ...... ? Lot 6 bdivision ..................................... Filed Map No ............... Lot ............... (Name) lc existing use and occupancy of premises and intended use and occupancy of proposed construction: condemned (forme~-ly a hotel building) F. xisting usc and occupancy ....... ; i ~ .' .......... ntended use and occupancy............o.....N°ne ......................................... . . . ..... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repzm' .............. Removal .............. Demolition....X.X., ........ Other Work ............... (Description/ 3436.70 4. Estimated Cost ................................... .... Fcc ...................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ..... 1..6 ........ Number of dwelling umts on each floor. ~/.~/..4 ......... . If garage, number of cars ........................................................................ 6. If business, commercial or mixed occupancy, specify nature ;md ex tent of each type of use ..................... 7. Dimensions pt' existing structures, if any: Fro,t ............... I{ear .............. Depth ............... Height Number of Stones Dimensions of same structure xvith alterations or additions: Front ................. Rear .................. Depth H il.'ht Nt ~ber of Stoa $. Dimensions of entire new construction: Front ............... Rear ............... Depth ........... ' .... Height ............... Num bet of Stories ........................................................ 9. Size of lot: Front ...................... Rear ...................... Depth ...................... 0. Date of Purchase .Ne-v. om'~r. -1.3, · .1.¢91 ........ Name of Former Owner . [~.o?{a. Ekg,,z.Y-)4./~,~-.t~Ob-orL8.1~i .... · usc ' 'c ' % ' . ........... .......... · Zone or dlstri t m vhmh premises are situated. . .1.1Fih.~. commercial ..... 2. Does proposed construction violate any zoning law, ordinance or rcgolation: .n. 9..': ............ ' .............. 3. Will lot be regraded no .......................... ~Vill excess fill be removed from premises: Yes No ' 4. Name of Owner of premises Al.f.z:ed. R....Gre.~e ~. ,JkZlaress . .P.o.:~ .gyve ........... Phone No. ?.88:72h..9'.. '. '.. Name of Architect ........................... Address ................... Phone No ................. Name of Contractor 9.r.e.b.e../p.I.C.K. ~ .8..G.A..~. 9.E.,.. Address ~.h.l.~ .1,e.r..A.¥.e: .... Phone No. 7.8.~-.72~.9. ..... i. Is this property within 300 feet of a tidal wetland? eyes ........ No..~ ..... · If yes, Souchold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether e. xisting or proposed, and. indicate all set-back dimensions from 'operty lines. Give street and block number or description according to deed, and show street names and indicate whether tenor or coruer lot. 493' 243' 125' TE OF NEW YORK. ' 'NT SUFFOLK S,S , Y OF ................. Alfred R. Grebe, Jr. being duly sworn, deposes and says that lie is the applicant (Name of individual signing contract) : named. the ......................................................................................... (Contractor, agcnt, corporatc officer, crc.) d Owner or owners, and is duly authorized to perforzn or have performed thc saki work and to make antl file this at/on; that all statements contained in this application arc true to thc bcst of bis knowledge and belief; and that the will be pcrfo~cd in thc manner set forth in the applicatio, filed therewith. to before /nc this ........ ...... ,9)/ , .....