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HomeMy WebLinkAbout10683-z FORIII NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE pREMISES UNTIL FULL COMPLETION OF THE WORK AUTrlORIZED) Nt,) 10683 Z Date .....U~.....d().. ............,.., 19f{). Permission IS hereby granted to: .....";OS?f/...L...79.7&N.st:=Jv.O.. vk. .../..5/3.5.....k d.t&!.. .;:f'Q.6I. i?"...." .....E6J:$.T.....&r.S/.C.I..Qi.J......,' . ,..' to ....C.0.t.vS.T/.t:.0.C./..........4,.~.a..~~.,... FiEl!..f..Cc................,.........,....,.....,.............." ., .............................................................................. ", ............................................................................ ot premises located at 1&/:;.s:....H.ri-lIJ.../.(G,6;/J?../...&):S.{:../V,6Y!r/.OA.)I'J..I..y ................................................................................................................................................................ ....................................................................... ...... .............. ................................................................... pursuant to application dated ...... W-4..'1......t., ,.................., 1,Jl;)., and approved by the Building Inspector. Fee $./.::L.~... .' ~ ...,... ........ ................................... Bui ing Inspector , , , it FORM NO.3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHPLD, N.Y. NOTICE OF DISAPPROVAL File No. ,..,............ ....,......,. Date, ../-liJ. ry.. /.;; .. .. .., 19 . (q :;: f-- - To 05,2fI(..,:" /rfWI!5~4' .:Ire, .. .?::I( . ,f:(,<J.lt!-). .:5T " ,....... .. r;r/."~N?,(){{I,-:-. A/.f:... PLEASE TAKE NOTICE that your application dated .... d A. ~1' . . . (. . . . . . ., 19 .cPO for permit to construct. . . . . ky.e.. e-. , . . , . , . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . , . . . at Location of Property ..1/105;... .H,/-',/.tY. .1C6Y.'9..<::?............ .z... /:{...{Jk.(~.;.p Hause 0 Street Hamlet .2 - County Tax Map No. 1000 Section Q ,;;;L. ( . , . . , . . Block .. Q. ~. , . . . . . Lot ,.G L.O. . . . . . ~ - Subdivision. . . , . . . . . . . . . . , ,. Filed Map No. ,............... Lot No. ...... .-:-. . . . . . . . . is returned herewith and disapproved on !he following grounds .~yt? -(lIt. C/,J,7i q Ii!. . . (..)0. {. . . . {!..().Hf?.I~'f?.:-:-.... .AI:-/?I!S... /!,?r;... .:t!... f!(/(.. t.i.:;5r.~9... ........................................................... . ........ ... ........ .... . ................................... . ................... .. RV 1/80 ).,__'-1 "1 " i~ T';) - , FORM NO.1 ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined 11<X{. .i: Q . . . ., 19 <fQ Application No/9t5. ?'$.... . . . . ApprovedtY(?'1.. .?q....., 19@ Permit No. .lQr; f~:2 ",""'~"d oJ' . . . . . . ... . . . . . . . . . . . u . . i . . ~t(1lj'" . ...... .... ,... ,......... (Building Inspector) I' APPLICATION FOR BUILDING PERMIT Date. ./18,y. .i'i~ . . . . . . . , . ., 19 .~Q INSTRUCTIONS ~. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building In,netor, with 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, 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 Buildmg Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises availa1:>le 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 applicaJ)t agrees to comply with all applicable laws, ordinances, b\lilding code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary ins ections. ~& ' .(.. ... .~//~~~.. ~ .. .... ( . natur of applicant, or name;i a c . oration) , .. (J+({ .11.":-:.:. ."~ t~:e.f(."/.,.;;;iV)/ , (Mailing add ss of applicant) j If Y ~I , , State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Owner ..,........ ,..................,......,.................... ,...................,...,........,.... /Name of owner of premises ... .~~se.~~ .L.. .~~~s.e.r:~,. .~Z:'. . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. .........................., ,.,.. ,..,....,..... (Name and title of corporate offIcer) C), / Builder's License No. ,.., ./~ { ~: .". . f!.r Ie.. f~... (. -<. Plumber's License No. ........................ Electrician's License No. . ................... . , Other Trade's License No. ..,...,............... I I. Location of land on which proposed work will be done. .....................,..,.,......,.....,......... \( " ' .N/s. .Na.:i,o. .R.d..,(. ,a,dj.a.c.e.o.t. ,:Qa.m .J>o.o.d ,!3.r.idge.).,. .Ba.s.t. Ma.r.i.o.n. ........, ,... ................... -, House Number Street Hamlet I<' County Tax Map No. 1000 Section .3.J. . . , . . . , , . . . . .. Block . .5 . . . . . . . ' . . . . . .. Lot.....12 .1Q . , . . . . . . . . Subdivision . . . . . , , . . . . , , . ........... . . . . . . . . . . Filed Map No. .. . . . . , . . , .. . . Lot. . . . . .. ' . . .. . . . (Name) 2, State existing use and occupancy of premises and intended use and occupancy of proposed construction: '{- a. Existing use and occupancy . . .Ql1," .:J:a.I11Uy. .dw,"J.J.:i.l1g . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . '( b. Intended use and oecupancy ., .~8,11)~ . . ~. ~. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I >A. , ! , , _~, _"'" --<C..t, . ."" ,~h,j, J' ii d,,'. ~ > ,1. . 3. Nature of work (check whieb applicable): New Building. . . . . . . . . . Addition. . . . . . . . .. Alteration .......... Repair .............. Removal . . . . . . . . . . .'. .. Demolition .............. Other Work. . N(aw. Fence. . . . 1 ' , 'pf (Description) , ! -cfeJ ')( 4. . 00 ' (' :)-. Estimated Cost. . . . . $$. . . . . '1' . . . . . . . . . . . . . . . . . . . . . . . . Fee . .. .................................. (to be paid an filing this application) 5. If dwelling, number of dwelling units. . . . . . . . . . . . . .. Number of dwelling units on each floor. . . . . . . . . . . . . . . . If garage, number of cars .... .1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. If business, commercial or mixe\! occupancy, specify nature and extent of each type of use . . . . . . . . . . . . . . . . . . . . . 7. Dimensions of existing structures, if any: Front. . . . . Ifl k . . . . . . Rear .............. Depth . . . . . . . . . . . . . . . Height' ............... NUn\ ber of Stories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dimensions of same structure with alterations or additions: Front ................. Rear . . . . . . . . . . . . . . . . . . Depth. . . . . . . . . . . . . . . . , . . .i . . Height . . . . . , . . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . . . . . 8. Dimensions of entire new construction: Front. . . . . . . . . . . . . .. Rear . . . . . . . . . . . . . . . Depth ............... , '/. Height ............... Nuni ber of Stories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . A9. Size of lot: Front . .i!i!Q~. . . . .i. .. . . . .. . .. Rear.... .500! .. . .. . .. . .. .. Depth ..... .SQQ... ..... .. .,. 11/79 · ~. Date of Purchase ...... ....:.................. Name of Former Owner. . .Edeet:l.RQt:l9.1d. . ........ .... II. Zone or use distriet in which pr~mises are situated. .One .t'a.mily .Residential. . . . . . . . . . . . . .. . . . . . . . . . . . . . . 1'2. Does I1roposed construction violate any zoning law, ordinance or regulation: ., .no. . . . . . . . . . . . . . . . . . . . . . . . . . . 13. Will lot be regraded .. ~~ . . . . : . . . . . . . . . . . . . . . . . . . Will excess fill be removed from premises: Yes No 14. Name of Owner of premises. . J . . . . . . . . . . . . . . . . . Address. . . . . . . . . . . . . . . . . . . Phone No. .. . . . . . . . . . . . . . Name of Architect .........;................. Address . . . . . . . . . . . . . . . . . . . Phone No. ........ . . . . . . . Name of Contractor . . . . . . . . : . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. .. . . . . . . . . . . . . . PLOT DIAGRAM , Locate ,clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-baek dimensions from property lines. Give street and bloek!number or description according to deed, and show street names and indicate whether interior or corner lot. I IV rJ, s-J / ocJ c) 11 5((....1. 3/ /'" bloc k .:> I , t...",-r ID '. , . New '-, I Chat"- [.....Ie.. {P! ~ /' ..... r"""( <. , V , 1-/ e'" t,-r- 1.../ ". , 13>7 e- ~ "" (:.~ -010 1--__;_ &"_ . .;' (..."",'11; - ". 131 /'11 ~ .2..2.()1 :;;. ~/" 1\0") ,- (3Ir')'} 'L .5 ,1" Io~cl<. .2. ( "'10 , P"f('v/',( L,,, f / STA TE OF NEW YORK, I S.S COUNTY OF .qU,f.f.qJ.k . . . . . . . . . . . . . JJP~jQi:~mwn1Q\1'\1!~~. I. Joseph .1. .Townsendl .JJ!;J"ing duly sworn, deposes and says that he is the applicant (Name of individual sig~ing contract) abov(~ named. , He is the . . . . . . . . . . . . .Owner . . .'. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I (Contractor, agent; corporate offieet, etc.) of said owner or owners, and is dJly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this applicatian are true to the best of his knowledge and belief; and that the work will be performed in the mann~r set forth in the application filed therewith. Sworn to before me this . . . 6. .th .. . . . . . . . . . . . . . ay ~f . . &y; . 't:-. . . . .~9 . BD - P . ~<-~ "'4,/1 JZ Notary ub R' . . . . . ... " ty , Y P lIC OF NEW YQRK \ " ' ,~ J . (Si . . a~;;li~a'n't) ReSldl g In Suffolk County : .. Clks, No. 52.9366350 : ommlsslon Expires March 30, 19~ a;1.-