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HomeMy WebLinkAbout16496-Z IPORM NO. 0 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NO_ 16~96 z Permission is hereby grant~ , ', /~ ~ , · ...~..J.~.~....32 ................................................ _ ~.~ ...... ~.,..~..,..j..,..~.~..~..~. ~ ..... ....... ..................... at premises located at ..~.,,~,...~.,....~~....~ ...... .~.~ ................... County Tax Mop No. 1000 Sec, tt'6'~,.. J ~.,,~- Block ~ I ...... ~ L ..... pursuant to application dated~~...~.......,~./. ........... , 19..~..~., and approved by the Building Inspector. Rev. 6/30/80 1FLD I::S!' C:IU,V �JllATE �I COMMLNTS C, 3� H C FOUNDATION ( 1st ) Cf FOUNDATION ( 2nd ) 2 . ' � z o ' ROUGH FRAME & PLUMBING cn 3 . x INSULATION PER N . Y. STATE ENERGY CODE x _ a r 4 . ----�y 0 vo FINAL -- - I O z ADDLTIONAL COMMENTS : x� x H � H .Cn O J a m H BOARD OF HEALTH .a' . . . . 3 SETS OF PLANS . . . . . . . FORM NO. I SURVEY . . . . . . . . . . _ • TOWN OI= SOUTHOLD CHECK • - • • • • • - - BUILDING DEPARTMENT SEPTIC FORM . . . . . . . . . . . . . TOWN HALL NOTIFY SOUTHOLD, N.Y. 11971 CALL TEL.: 765 1B02 . . . . . . . . . . . . . . -� MAIL TO : Examined 19 1 Approved Q. ° .) . . �. . ., 10.7. Permit No. Disapproveda/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . •1.Ct• . . . . . . . . . . . . . . . . . (Building Inspector) APPLICATION FOR BUILDING PERMIT Date . . . . .. 19 8i INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 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 stree or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appl cation. c. The work covered by this application may not be.comrnenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such perm shall be kept on.the preinises 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 Occupanc 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 tli Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances c Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe( The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and t admit authorized inspectors on premises and in building for necessary inspections- (sign ire o 01cant, or Warne, if a corporation) 115?- (Mailing address of applicant) State whether applicant is owner lessee, agent, architect, engineer, general contractor, electrician, plumber or builde . . . . . . . . . . . . . . . :. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of owner of premises . (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Name and title of corporate officer) ALL CONTRACTOR IS IJUS PE S FFOI.K COUNTY LICENSED Builder's License No. . . . . . . . . . Plumber's License No. . . . . . ... . . . . . . . . . . . . . . . . . Electrician's License No. . . . . . . . . . . . : . . . . . . . . . . Other Trade's License No. . . . . . . . .. . . . . . . . . . . . . . 1. Location of land on which proposed work will be done. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . �Y. . . : . . . . . . . . . . : . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . House Number Street Hamlet County Tax Map No. 1000 Section . . . . .�.�.Z: . . . ....,. . . Block. . . . . . . . . . . ... . . . . . . Lot . . . . . . . . . . . . . . . . . Subdivision . . . . . . . . . . . . . . . . . . . . Filed Map No. . . . . . . . . . . . . . . Lot . . . . ... . . . . . . . . . (Name) 2. State existing use apd.occupancy of premises and ihiehded use and occupancy of proposed construction: a. Existing use and occupancy . . .C. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b. Intended use and occup •7� 3. Nature of work (check which applicable): New. Building . . . . . . Addition . . . Alteration V/ . .' . . . . . . . . . . . . . . . . Removal . . . . ... . . . . . . . . .Demolition . . . . . . . . . . . . . . Other Work . . . . . . . . . . . . (Description) 4. Estimated Cost . . . . . . . . . . . . . . . . . . . . . . . . . Fee . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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 . . . . . . . . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . . . . . . . . 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. Will lot be regraded . . . . . . . . . . . . . . . . . . . . . . . . . . . . Will excess fill.be removed from premises: Yes P 14. Name of Owner of premises .Saaro. � .S,kp-.r,. . . . Address . . . . . . . . . . . . . . . . . Phone No..,. . . . . . . . . . . . . Name of Architect . . . . . . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . Name of Contractor . . . . . . . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. : . . . . . . . . . . 15. Is this property located within 300 feet of a tidal wetland? *Yes '. . . . . No . *If yes, Southold Town Trustees Permit ma be reyuired. � PLO DIAGRAM Locate clearly and distinctly all buildings, whether existing or. proposed, and.indicate all set-back dimensions fro property lines. Give street and block_ number or description according to deed, and show street names,and indicate wheth interior or corner lot. S � STATE OF NEW YORK, S.S COUNTY OF . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . being duly sworn, deposes and says that he is the applica (Name of individual signing contract) above named. Heisthe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Contractor, agent,.corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have perfonned the said work and to make and file tl application;` that all statements contained in this application are true to the best of his knowledge and belief;and that t work will be performed in the manner set forth in the application filed therewith. Sworn to before me this . . . . . . . . . . l. . . . . . . . .day of. ����. :. . :, 1967 Notary Public, v.U. J.v !.� . . . . . . County t . ,•. . • (Signature of applican F32- _ Iry �x�1Ti"VcC. ST O T,-� E cr iow �; ICE . 1, CAFE n CAFE E I TEIN-► S I ONJ 1/ CID ,T P-T �- a -- -R E-TA i 1032,5 - � �ARLo'iZ � I O FF+c r �� -- - -� MALL k T LJ� 103LG 103 + Io3'+ 10351 M PAL _1 4 (70CK SNo-frINtC- CEMTE \N ST 61 DE 6 F :M A LL MALL EAST elzcIRS f f ��� ,.S s New; }� STO R 6'2i aK c GeeR G U CAFE EXTEMStON L c A L w =--- 3�x -RE7A L o325 n .T -etA0T-� �t ARLOTt f i GLOM ar, ( OFF+ct lr I `} MALL 4cIF—ST WALK ' 103`F3 103t5 103fl 1035 Pam- M hit_ i Mh--TI-rOCK SNo-frltic- CENTF- ---- WEST !S(bE GF -MA" -� MALL EAST kx/ALlL SCALE Z511j,"= OF 81z0(9Z OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICATE OF OCCUPANCY -&WMDVW AS MOTO F E E —By- —V. NOTIFY BUILDING DEPARTMENT AT 765-1602 9 AM TO 4. rM POR THE F®LL LNG INSPE POUNDATION INVO REQUI f MIR POURED CNE s E 40UGH FRAMING & 'Pr UMI BI & INSULATIOP! 4. FINAL CO STRUC 'v N MU!9f BE COMPLETE R C'00 ALL CONSTRUCnI GIN SHALL MEET THE REQUIREMENTS OF F- N.Y 2!T,A,TF- CONSTRUC n(W & ENS CONSTi t,�1 110N