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HomeMy WebLinkAbout6207-z FORM NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6207 Z Permission is hereby granted to; ~ ....~.~.:~....~.~......~.....~ .... ....... ~.~....?. ......... ~ ....... ~ ..... ............................. ............. '~.:!...~ ...... ~.L.....~.~.~ ...... ! ..................................... ! ............................. at premises located at ..~.~..~.......~.......~....~....~..-..~../. ................................................ ................ ~~..~....~.: .............. ~..C ....... ~ ............................. pursuant to applicatlon dated .................... ~....~....~... ....... , 1~.~..., and approved by the Building inspector. Building Inspector/ TOWN OF SOUTNOLD TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ...... ~:....~...~. ............ , 19..?....~ Application No ..... .~.....~...0...?. ..............~ Approved ............................ , 19 ....... Pemit No ..... ~.~......0...~....~ \/~)t ~ D,approved a/c '¢ ............. X' s ll ....................... ....... ................. ....................... ............. /~ -.1 ~/'~ APPLICATION FOR BUILDING PERMIT ~,, ~.~ pcc~, gate ...L.~Ig.Q~J ....... ,,.~. .................... 19.~; ........ "~ INSTRUCTIONS ~, a. This application must be ~ompletely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, wi_l~ 3 sets 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, ar~ glwng a detailed description of layout of property must be drawn on 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 the premises available for inspection throughout the work. e. No building shah be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have bee'~ 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. (Signature of applicant, or name, if a corporation) 217 (;shot-ne ~-~ve. ;ivepnea-' .~. Leet,zapcJ itcres a-,'; 3ayy. ie~¢ (Address of applicant) State whether applicant is 9w_p_e_L, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..... ~.~.~3.,~,qJ:.;l..t.~m:.c.~...J.[;~... ................................................................................................. If applicant is a corporate, signature of duly authorized officer. ?) " /~ 1Z--~, (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ..... ~.2,~ ......................................... Lot No. Street and Number ....... ~./&..9%...~.?.~Y~.~.;~...,.t. Li.M~ .................................................... ;¢~.~j.~.~ ............................. MunicipaliW 2. State exi~ing u~ and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .................................................................................................................................... b. Intended use and occupancy .... ~.~.~...~.~.~.~ ....................................................................... ~..,., ...... 3. Nature of work (check which applicable): New Building ....................... Addition ..................... Alteratioh ......... ,....~ Repair ............. ............ Removal ......................... Demolition ........................ Other Work .................................... 4. Estimated Cost ............................................... Fee ...... ~...~. :../..~.~.....~. · ;. ~ Description) (to be paid on filing this application) 5. If dwelling, number of dwelling units .................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 ....... I.~,?. ........................ Rear ....... J.~..[ ............................ Depth .....~.~. ..................................... 10. Date of Purchase ..................................... Name 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. Willlot beregraded .............................. Will excess fill beremoved from premises: [ ] Yes [ ] No · Leetva*d ,~r~l~eS Itq¢. 2,17 Osborne ~ve, ~vel~headz ..~. 727-,? 14. Name of Owner of premises ............. ~ ...... .~ ............................. ................................................................................... (Address) (Phone No.) ' Name of Architect ....... .s..a..~.~ ............................................................................................................ (Address) ~ 2 ~.h~,~.) Name of Contractor ................. .,.s..a..~.?. ......................................... i~,~'~'s'l' ................................... i~l~'~'~i ............... PLOT DIAGRAM Locate clearly and distinctly ali 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 wheth- er interior or corner lot. STATE ~~.; ..~..~.~/~ ~ be lng duly sworn, deposes and says that he Is the apphcant above named He is the ..................................... ~.~..~....C...,...~....%:........~ ......................... ;%' ........:'"; ........................................................ ~ / (Contractor, agent, co.rate Olltcer, etc./ of ~aid owner or owner~, and i~ duly authoriz*d to ~rform or haw ~r~ormed the said work and to make and file thi~ ap¢ieation; that all atatemant~ containad in thi~ a~licatio~ ar~ Ir~* ~o t~ b~at of his knowledge and bali~f; and that th~ ~ork will bo ~r[orm~d in tha ~nn~r set [orth in tho a~¢ieation fil*d thar~with. ......................... ........................ . PRI VE S52~29'30"E. 185.00' Arco-- 42,550 SCl. ft. ~--Lot51 -- ~ - ~Lot50 /v 52 29 30 W -.---~Lo! 5/~ ~ I 185.00' . Lot 50- FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ...... ...~.~. ~r..~.,..~ .~. ............ , 19..'9....~ Approved .............. ~.). ........ ~.~. ............. , 19...'.~... Pemit No...~.~..g...~...~ .... Disapproved a/c ~ ~: ~ ~~ ~ ........................... .................................... (Building InspectOr) Applicotion No. ~ )- (3 -~ ~: APPLICATION FOR BUILDING PERMIT Date ...C~cL o h~,j ..... ,7,~, .................... 19.:Z, ....... 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 schedure. . 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 of property must be drawn on 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 prem.lses 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 o;[ Occupancy shall have been grarlted by the Building Inspector. APPLICATION tS 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. ord inances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) 217 Osborne Ave. Rive~,head, ..... ................. (Address of applicant) State whether applicant is _o_wn_er__, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..... I,~.~.<~F...~h.~,GP..C.w...J.n~. .................................................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) ~' 1. Location of land on which proposea work will be done. Map No.: ..... 9.Q.e.. .......... ,...;.;....,..;..; ........ ..;. Lot No..5..O....~.-~,1~~. Street and Number ....... ~.Z.~...9...~..,..L..e..e..~f..a,E.~....D...r'.J..Y..e. ............................................... :~.~.l~t~.~.j.~,~ ............................. " Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .................. b. Intended Use and occupancy .... ~N*=ture of work (check which applicable): New Building ....................... Addition ..................... A tara~rr~ ............... Demolition Other Work ~ 2' Repair Removal ~ Description ) 4. Estimated Cost .............................................. Fee ...... ~,ilf.~.::,/,~,,."..~.,J.: .................................................................... (to.be paid on filing this appliCation) 5. If dwelling, number of dwelling umts ................. Number of dwelhng umts 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 ,~r ....... J....~, ........................ Rear ....... J,~,..~ ............................ Depth .....~.~.0. .................................... :' 10. Date of Purchase ..................................... Name of Former Owner ............................................................................ 11. 12. 13. 14. Zone or use district in which premises are situated .................................................................................................... Dobs proposed construction violate any zoning law, ordinance or regulation: ............................................................ Will lot be regraded .............................. Will excess fill be removed from premises: ] Yes [ ] No · Leet~a'd ,\e~-es Inc. 217 Osbo~'ne Ave. '~..y~E.h~,..~..~= Z~.?.7~ Name of Owner of prem~s .................... : .................................................................................... ~ (Address) (Phone No.) Name of Architect same (Address) 7 2~.) Name of Contractor .......................................................................................................................................... sar, e (Adding) (Phone No.) *'T*~ PLOT DIAGRAM Locate clearly and distinctly all building, whether exi~ing or propo~, and indica~ all ~t~k dimensions from pmperw lines. Give street and block number or de~ription according to d~d, and ~ow ~et n~es ~d indicate whe~- er interior or corner lot. STATE OF NEW ) S~ ' ~ COUNTY t I being duly sworn, ,d~..~. ~s and say~ ~,he ~ the applicam above ~' He is the ........................ of said owner or owners, and iS duly authorized to ~dorm or have ~ffor~d t~ ~id ~rk and '~ ~'~ file~ I state~nts contained in this application are true to t~ ~st of his k~wl~ a~ ~li~ a~ ~t ~ ~ ~11 ~ set forth in the ap~i~tion fil~ therewith. ~,'~,'..~ Notary Public, SUF~_..K COUNTY DEPARTMENT OF HE~,,TH H.D.Reference APPLICATION FOR APPRO~AL TO CONSTRUCT PRIVATE .SEWAGE DISPOSAL SYSTEMS Approval to construct said systems is requested,pertinent data herewith: Date 1-Applicant Le~ard A~, In~. Phone ?~7-656S-Sub ~iv Leet~ A~e8 et Address A R d N 7-Sectmon 2-Detailed p~pe~y location Hamlet~[~ ' To~ ~ ~ 9-Private well? ~ ,, 3-~blic ~ter supply ~me Distance to nearest ~in 4-Lot Size: Width~ft. Length~ft. (also enter on center plot plan below:) 5-~elling: Singl~ Family ~ T~ Family? ~ /Cellar? ~/~lab? 10-Pro~sed system. Septic tank ~Preca~t.~Cess~ols ~Shall~w ~els ~ /Other~ Il-Septic ~ inside dimensions: Vol~e~Gals. Length. ft. Width~t' Liquid dept~ft. 12-Precast sections. ~/Number~Square~. Cesspools. Block size~incs.D $ins. H~ins. Total blocks below inlet: ~1/*~ PLOT PLAN Capacity~l Gals. P.M. I0 Street Ind~ Data ~ , eet leam 0 ~6 e The Undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the 3uffolk County Health Departments' current Standards, Bulletins, and amendments t.hereto, covering Private Sewage Disposal Sys~ems~ FOR HEALTH DEPARTMENT USE ONLY. Based on the inform~tmon l~'~esented herewith, it is the opinion of the Health Department, that an adequate and satisfactory Sewage Disposal System can be installed on this Plot~. Date ~F/~,/I~__ (10/65 Revis.) S-15 ' LEEWAt?D DF ~--LotSI Area = 5~, )7 sq. ff. oi51 ___~-~. Lot50 Haze/ B, Mo ctr ~,~,l~flt'l$10N M&~ ~IL ~D IN ~E OI~"I~E' d~W~" 4~ 19~'145 FIL-~ N~. IF_'-- t _? Il fir! t!