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Home My WebLink About15489-z FORM NO. · TOWN OF SO~THOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PEPJ,~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 15489 Z Perm~ssron is hereby granted to' ~...~~.~.~.~..~. .... ......... ~.~....~_ _.~. :.~. ...... U.?..~.~. .............. at premises Iocatea at ....... . / ~ ..... · ~.~~.b. ..... ,1~ ..... : ...... ..,~.. · ......... . ................ t .......... County Tax Map No 1000 Section ..... J I .'7,, pursuant to apphcat,on doted ...}0...~c~,. ~ Budding Inspector Block ..... ..~..~.. ...... Lot No .,~...~ 7 ...... . 192g,, and approved b~ t~,. Building Inspector OUNDATION (1st) OUNDATION (2nd) OUGH FRAME & PLUMBING iNSULATION PER N. Yo STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: o I VUALL FERN1 NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y, 11971 TEL. 765-1802 Examined 19 2.% Approved .k~.~. I'~, 19W¢ Permit No./ g~/ ~.~ .'~ Received ........... ,19... Dmapproved a/c ................. (Budding Inspector) APPLICATION FOR BUILDING PERMIT Date l,]9y.e..mD..e.r' .6... ,19 .8.6. INSTRUCTIONS a Ttus apphcaUon must be completely filled m by typewriter or in ink and submitted to the Bmldmg Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule b. Plot plan showing locahon of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detaded description of layout of property must be drawn on the dlagmm which is part of this appli- catlon. c. The work covered by fins appl,cation may not be commenced before issuance of Budding Permit. d. Upon approval of tins apphcat~on, the Budding Inspector will issued a Budding Permit to the applicant. Such permit shall be kept on the pr?nines avmlable for mspectmn throughout tile work e No bufldmg shall be occupied or used m whole or In part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Bmldmg Inspector APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Btaldlng Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulahons, for the construction of buddings, addihons or alterations, or for removal or demolition, as hereto described The applicant agrees to comply with all apphcable laws, ordinances, budding code, housing code, and regulations, and to admit atttkorized inspectors on preinises and m bmldmg for necessary ¢x,qpections (Si,,nature of applicant, (1/name, if a corporation) New Suffolk Avenue Ne.w .S~..f f.o. lk., .N. ew...Y.o.r.]~..1.1.9. 5 ~ ......... (Mailing address of applicant) State whether applicant ts owner, lessee, agent, architect, eno~neer, general contractor, electncmn, plumber or builder. Owner Name of owner of premlses . R. ob.~.r.L.S.l.e.dzgl~$k& iltp..d. ~.qn.~'~.q$~t S.],~0.,zS,~IS.L .................... (as on the tax roll or latest deed) If applicant is a corporation, slguature of duly authorized officer · ~/A ..... x (Name and title of corporate officer) Builder's hcense No. .N/A ....... PlumbeFs License No .N ./.A ........ Electrician's License No .... N./.A ......... Othci Trade's hcense No I~/~ ........... Location of [and on which proposed work will be done ....... ~O/.~ NO~..~uff~.lk Avenue .... ltouse Number Street .Ne.w Su .f folk ......... Hamlet 2 County 'Fax Map No 1000 Section .. J-.~7. . Block .6 ..... Lot .... 24 .......... Subdivlsmn N/A .. Filed Map No I,J/..~ ...... Lot .. . I?I/,A. .. (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction a Existing use and occupancy .g.r.e.enhou.s.e ........................... b. Intended use and occupancy N/A 3. Nature of work (check which applicable). New Buddm~ Repair -- Removal -7 .... 4 Estimated Cost . ~.1.,.85.0..00 ....... 5. If dwelling, number of dwelhng units . N/.i~ ..... '~-. Addition 9-l:~e4nbgP~ Alteration --.. .. Demolition . -.-.... Other Work.. -:- ........ (Descnptmn) (to be paid on fihng flus apphcahon) Number of dwelling umts on each floor . .N/A... If garage, number of cars .... [q/A ...................................... 6 If business, commercial or mixed occupancy, specify nature and extent of each type of use .. NrA. ........ 7. Dunensions of ex&sUng structures, if any Front. -7 ........ Rear .. . .-.'- ........ Depth .... -.- .... }telgbt .n- . .. Number of Stories . ~I/A .......................... Dnnenslolr8 of same structure wlth alteratlons or additions Front .. :-.': ......... Rear ... :-:- ........ Depth .. -': .......... Itelght .. . :-.-' ....... Number of Stones...N/A ........... 8. Dimensions of entire new construchon Front .. ':': Rear . .-': ...... Depth .... --.-: ....... Itmght . - .r ...... Number of Stories -- . ................................ 9 S~zeoflot Front .... 95..0 feat .. Rear...$.5,0.~ee~ ..... Depth ..kT.0...9..f.e.e..t ....... 10 Date of Purchase ~0/79 ...... Name ofl~r~ Owner AlZst~ .Greep-kqgses. 11 Zone or use d~stnct in winch premises are situated "A.". Re$.iden. t.J..a.1/A, gri.¢u. 1.t.ur..al ....... i i 12 Does proposed construction violate any zoning law, ordinance or regulation . . ..No .............. 13. ~Vlll lot be regraded .... I~O ........ Will excess fill be removed from prenuses: ~z~ No .. u o ue .7.~4rSA34... 14 Nan, e of Owner of prem,se~Qk~rt~ IS~e~½g~. Addres,~t~ iU~o~/A~.e~. VhoneNo Name of Architect N./A ..... Address . . .-': ........ Phone No .... -.". ....... Name of Contractor . .N/A .......... Address -- Phone No ....-.L... 15. Is th~.s property located with~.n 300 feet of a tzdal wetland* *Yes ..... No ..¥.. *If yes, Soutbold Town Trustees Permit maybe required. PLOT DIAGRAM Locate clearly and distinctly all buddings, 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. See attached copy of survey of Roderlck Van Tuyl, P.C. dated October 6, 1975. CTATE OF NEW YORK, 2OUNTY OF S. UFFOLK ..... S S .. .R.O BE .RT. $I~D. KIIISK% ....... (Name of individual signing contract) ~bove natned being duly sworn, deposes and says that he is the apphcant leis the . . o.n.e. O~ .the.o~rler~..... ...................................... (Contractor, agent, corporate officer, etc ) cgxa~Rx~texx~xx~m~, and is duly anthonzed to perform or have performed the said work and to make and file flus pphcatmn, that ail statements contained m th&s apphcat~on are true to the best of his knowledge and belief, and that the ~ork w~l be performed in the manner set forth tn the application filed therewith. ,worn to before me flus ...6th. .. day of ~v~.m~..~r ........ 19.~6 ,~otary Public ...... Su f.fql, k. ............. County ^ o. c.u, .... NOTARY PUBLIC, State of New No 4635190, Suffolk Coun~ ~mmms[on ~p~ Oc~ber 30, 1988 ~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .......... ~.~.! ........... 19. ?~.. ~ ^pphcohon No ......................... ............... i .... Z.Z., (Bullring Inspector) APPLICATION FOR BUILDING PERMIT t//?.' ..7..: Date ..................................... , ]9... INSTRUCTIONS a Th~s opphcohon must be completely filled zn by typewnter or m ink and submitted in triplicate to the Buildi Inspector, with 3 sets of plans, accurate plot plan to scale Fee according to schedule b Plot plan showmg Iocahon of iot and of buddmgs on premrses, relohonshlp to odloming premises or public streets areas, and gwmg a detaded descnphon of layout ofproperty must be drown on the d~agram which ~s part of this apphcah, c The work covered by th~s apphcahon may not be commenced before ~ssuance of Bu~ldmg Permm d Upon approval of th~s apphcation, the Buildmg Inspector w~ll ~ssue a Buddmg Permit to the applicant Such pen shall be kept on the premises available for inspechon throughout the work. e No buHdmg shall be occupied or used m whole or ~n part for any purpose whatever until a Certificate of Occupo, shall have been granted by the Budding Inspector APPLICATION IS HEREBY MADE to the Buddmg Department for the ,ssuance of a Buildmg Permit pursuant to ~ BuHdmg Zone Ordnance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordnances Regulations, for the construchon of buildings, addmons or olterahons, or for removal or demohhon, as herein descnb The apphcant agrees to comply with all apphcable laws, ordnances, bu~ldmg code, housing code, and regulations, and admit authorized inspectors on premises and in buddings for necessary mspections ,~gnature of opphcant, or name, if ?at, potation) (Address of applicant) State whether applicant ~s owner, lessee, agent, architect, eng~oeer, general contractor, electncron, plumber or Z: ~. /l ...... e. ~ .,C.;/<*,~,..:-~. ~;.~ .': .... ~-.'-4 . ¢: z ........................................................................ Nome of owner of prem,ses .... ~. ,.. ~.~'.; "Z: ...... ~..t,, ,1~ , e .,,~ ~..~' z. ...... "~.. .. ...C.~.T..~. .( .al..... ~.... If apphcant is a corporate, s~gnoture of duly authorized officer (Name and htle of corporate officer) 2 Builder's bcense No ............................ ~""'~' .... io c~a - Plumber's, k,cense No/....~>. ~.. :~. :? ~"' .......~..... ?..~.~ Electrician s L~cense Na ........................... Other Trade's License No ,/~..z:;rr.~<...,~.~ ...... ~.r..~ 177 Locahon of land on which proposed work ~11 be done Map No.. ~ ............. Lot No ......... Street and Number~. .~'~/~...~,~4/./".:' ..~ .... ~.i. } ~. L.~: ~.2..(.~ ................. State ex~stmg use and occupancy of prem,ses and ~n'er, ded use and occupancy o~proposed construction: a Ex,stung use and occupancy ............ ~. ..h:~..Z~Z:~ ............... b Intended use and occupancy .~ ...'2 v;...: . . m: .......~ ..(,.:.' ........................... /! 3 Nature of work (check which opphcable) New Bulldng Repair ... Removal ........ Demohhon. 4 £stlmated Cost .............. /. ...................... Fee 9 10 11 12 13 14 Addmon . Alterahon .Other Work ./,'c'~. ,~-' ' / ..././ (Description) (to be po:d on fihng thts apphcohon) If dwelhng, number of dwelhng units ......... Number of dwelling umts on each floor number of cars If garage, . ................................................................ If business, commercial or m~xed occupancy, specefy nature and extent of each type of use ...... D~mens~ons of ex~stmg structures, ff any Front , , Rear Height ............ Number of Stories ..... ~"~ ~- _~r -~..., D~mens~ons of same structure w~th alterations or addmons Front . .. Depth ................ HeJght Number of Stones .................. Depth · ..¢<: ............... ........... Rear t 8 Dimens~o¢,s of entire new construction Front ....... Rear ............ Depth Height ....... Number of Stones Dote of Purchase ..... -. . . Rear · /. ?O ......... , ......Depth ......... Name of Former Owaer ~ L .? .( .% . /.. ..... ............................. Zone or use dlstnct m which premises are s;tuated . Doe. s proposed construction violate any zoning law, ordinance or regutahon ....... ./'.<~%3 ..................... Wdl lot be regraded .. . f~//2 ....... Wdl excess fiH be removed from premises ( ) Yes ( ) No £ / r-/- ~/ /~ ,', ~ 4, Name of Owner of premtses.?...(; ~ ..... ; ........ /, ;. '../....,::', ( Address ...... / .: .,.~.Z...//.....J.'¢ Phone No. '7..~'.¢..~.[:1..~, Name of Architect .................. Address .~ .......................... Phone No .................. Nome of Contractor [ re- ~ ~ /Jla ~ [./ .~: m ~*, H . ;~,/d ............... '~ ' ~ .......... Address ,.:,',.,.~,,,~.,.c...&~. Phone No.~, PLOT DIAGRAM Locate clearly and dJstmctly all buddings, whether extstmg or proposed, and red,cate all set-back d~mens~ons fr property hnes G~ve street and block number or descnphon according to deed, and show street names and indic whether intoner or corner lot ¥ L being duly sworn, deposes and soys that he is the app}l~ STATE OF NEW YORK, ** ( S S counTY OF ~/ ........ // (Name of md,wdu~mng contract) ~bo~e named He ts the . . . (Contractor, agent, corporate officer, otc ) of sam owner or owners, and ~s duly authorized to gerform or have performed the smd work and to make and th~s apphcohon, that ell statements contained m th~s apphcohon are true to the best of h~s knowledge and behef, that the work wdl be performed m the manner set fodh m the apphcahon filed therewith Sworn to before me th~s Nota~ Pubhc,,,~ ~c~ ~'~~W~A .~'~'h~ .C°un~/ , '" ' ~ (S~gnoture of o~mont) ...... ~ ' ' J~*d~e of Ne~ York